Cream that ‘rubs away’ skin cancer
Tessa feared surgery would leave her face scarred. Then came an amazingly simple solution
AS i looked in horror at the angry red scabs that covered the right side of my nose, i t was hard to remember that all this started with a pimple so tiny i barely noticed it.
in fact, the spot seemed so insignificant i had ignored it for months. now i thank my lucky stars that i finally took action and went to the doctor.
My nose may have looked horrible for weeks during and after treatment. But it could have been so much worse.
The spot was a basal cell carcinoma (BCC), the most common form of skin cancer in the UK, with more than 200,000 cases diagnosed every year. A BCC normally looks like an open sore or a red, irritated patch, and occurs in the top layer of the skin. Mine — a nodular BCC — resembled a tiny pimple.
BCCs, unlike melanoma skin cancers, very rarely spread (this happens in fewer than 0.5 per cent of cases); but left untreated they can gradually eat away surrounding tissue, causing permanent disfigurement and the need for painful skin grafts.
Traditionally, they have been treated surgically, with the cancer and a small amount of surrounding tissue cut away under local anaesthetic. The BCC can be totally eradicated, but the risk of scarring as a result of surgery is high.
however, i was among the fortunate patients who are able to avoid intrusive surgery and the risk of scarring by trying a non-surgical treatment option — a topical cream called Aldara.
Like many people, i had no idea the cream was available and delayed going to the doctor as i dreaded surgery.
i first noticed the pimple on the right side of my nose in August last year. i’m 56 and hadn’t had spots since i was a teenager, so i was surprised — but not worried because it looked just like the spots i used to get. Besides, i thought skin cancer started as a mole, not a harmless-looking spot.
i blamed the ‘pimple’ on my suncream, and swapped to another brand. When it hadn’t cleared up after a month, i decided my diet was to blame and cut back on alcohol and chocolate. The pimple vanished for a few weeks, then back it came.
Sometimes it was raised, sometimes just a red mark.
ThiS changeability is a classic sign of BCC, i know now. But at the time the changes reassured me that there was nothing to worry about because i assumed that — as with cancerous moles — the spot would grow larger if it was dangerous.
By October, two months after i first noticed it, i realised that the tiny spot wasn’t going to shift.
i decided to visit my GP. Sitting in her consulting room, explaining that i’d come about a spot, i f elt embarrassed because it seemed so trivial. But, she took my concerns extremely seriously.
‘The spot may be tiny but there’s a hard ridge around it,’ she said, after carefully examining my nose. ‘That’s a clear indication that you have a basal cell carcinoma.’
Although i don’t ever remember burning my face badly, the GP explained that even mild burning, particularly in childhood, increases the risk of developing a BCC. And, as a fair- skinned redhead with freckles, i burn easily.
The doctor reassured me that the cancer was treatable and wouldn’t spread.
As BCCs are generally very slow-growing, my case was not urgent so i had to wait until the following February to see the skin consultant at the Royal hampshire County hospital, in Winchester.
As i waited i remembered how, as a child, i’d spent summer holidays in the heat of italy and then in my 20s i’d deliberately tried to tan. Was i now paying the price?
having read about skin cancers over the years, i was convinced that i’d need surgery and filled with horror at the thought.
There is a worry a mong dermatologists that too many people feel as i did — making their condition harder to tackle because they come to treatment so late. After examining me, the consultant confirmed that my pimple was a BCC.
She then stunned me by suggesting that, as it was not deeprooted and had been caught early, rather than surgery, i could treat it myself with a prescription cream, Aldara. This contains 5 per cent imiquimod, a powerful topical medication that binds to damaged skin cells and kills them.
in fact, imiquimod was first licensed in Britain i n 1997 to treat genital warts, explains Dr Emma Wedgeworth, a consultant dermatologist, based in London, and a spokeswoman for the British Skin Foundation. ‘But then tests showed it was just as effective on BCCs,’ she explains.
Using the cream meant there would be no long-term scarring. Although most people still need surgery, an increasing number of patients are being offered this alternative as a first option.
i had to apply a tiny dab of cream to the pimple and the area just around it five times a week for six weeks, rubbing in until it was all gone. Although it was winter at the time, i was also told to avoid the sunshine and to wear sunblock when i was outside, as imiquimod destroys the top layer of the skin, making it more prone to sun damage and the risk of other skin cancers.
however, as Aldara — which comes in sachets that each contain enough for two generous applications — is absorbed very easily, i found it hard to judge how much to use.
And i was so worried about applying too little cream t o destroy the BCC, i put on too much. As a result, the cream started to have a devastating effect on the area where i applied it, irritating healthy cells as well as the cancer.
it became a mass of red scales and for two weeks of the six-week treatment i wore a bandage over my nose to hide the redness. By the end of the treatment, the right side of my nose was so red and scaly, i almost wished i’d opted for surgery instead.
‘Unfortunately, side- effects are very common,’ says Dr Wedgeworth. ‘ The unhealthy cells become inflamed as they die and the surrounding cells also get irritated, leading to itchiness, tenderness and redness.
‘Some patients also complain of flu-like symptoms and give up the treatment before it’s finished.’
But even if you apply the cream too generously, there is no risk of long-term harm — and the sideeffects, which c an i nclude pigmentation changes, usually disappear within a few months.
As soon as i stopped, the red scabs began to vanish.
Two weeks later, although the tip of my nose still looked pink,
WiThin the scaliness had vanished. a month of stopping treatment, my nose was back to normal. At a hospital check-up in June, four months after i had begun the treatment, doctors e xamined my f ace under a microscope and confirmed that the BCC had gone.
‘it’s particularly effective in the two most common types of BCCs: superficial, where you have a red, scaly patch of skin; and nodular, where there’s a spot or pimple,’ says Dr Wedgeworth.
‘ For people with infiltrative BCCs, which have affected the deeper layers of skin, surgery is the best option.
‘imiquimod is effective for at least 70 per cent of patients first time, but it’s less effective at removing every scrap of affected tissue than surgery, which also doesn’t rely on patients applying the cream properly.
‘But because BCCs grow so slowly, imiquimod is a very good first option.’
i am delighted. i have been warned that i am likely to have other BCCs. Because they are caused by serious sun damage, especially in childhood, they rarely come alone.
But now that i have seen how easy it can be to get rid of BCCs, i will seek treatment as soon as i notice anything unusual.