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Published on February 25, 2019

Paying the price for childhood days at the beachPaying the price for childhood days at the beach

I got a bad sunburn 50 years ago – and now I’m paying the price.

To be more accurate, I had a lot of bad sunburns when I was a boy and a few in my teens and 20s. My mom was a nurse, but when I was a child spending long-ago summer days on Cape Cod beaches, parents didn’t worry about the future effects of sun exposure.

My dermatologist, William W. Fiske, MD compared cumulative sun exposure to a cup that’s filled drop by drop.

“When it gets filled it, it doesn’t matter whether it’s a new drop or old drop that pushed it to the top,” he said. With my pale Irish skin, my cup was smaller than many people’s, so I reached the overflow point a long time ago.

Last October he told me that there were several options for treating the actinic keratoses (AKs) that were on my forehead. AKs are precancerous growths that can turn into non-melanoma skin cancer if untreated. They typically evolve into squamous cell carcinomas of the skin. The ones I had were so small that they felt like a small grain of sand on my forehead, but they can grow into crusty or scaly bumps.

Dr. Fiske, who’s based at Cape Cod Dermatology in West Yarmouth recommended I try a cream (5% 5-fluorouracil) to destroy the AK cells, instead of cryosurgery (freezing the tissue) or photodynamic therapy, which uses a light combined with a light-sensitizing chemical applied directly to the skin before treatment.

For my particular situation and the degree of damage he saw on exam, he advised that the fluorouracil option would be the best approach. Based on his explanation, I agreed.

He told me that during the treatment the treated skin would get bright red and then start peeling. He suggested I find a time when I had a month or so with few social obligations, perhaps after the holidays.

When I got home, I did some Googling to find out more about Efudex and its side effects. One of the things I found was an online journal by a woman whose pictures were enough to give me second thoughts. Her face was a mess during the treatment. I’m not the vainest guy around, but I didn’t want to walk around looking like my skin was coming off.

I almost decided not to go through with the treatment. Then I talked to my sister, who had a melanoma removed, and my stepmother, who is a breast cancer survivor. They urged me to follow my dermatologist’s recommendations. I agreed to do so, but decided to start by treating just my forehead, instead of my entire face. Here’s how it went.

Treatment Journal

Day 1 – The prescription calls for me to apply the cream twice a day. I apply it to my forehead for the first time after Christmas dinner. I have a little trouble falling asleep. Maybe it’s anxiety about the treatment or maybe it’s the sugar rush from that second slice of pecan pie.

I don’t have any reaction the first few days, other than an occasional very mild itchiness on my forehead.

Day 7 – My forehead is sprinkled with about two dozen red spots. In the following days, the pale spaces redden as well, so that by the two-week point, my entire forehead is varying shades of red. It looks like I have a bad sunburn, but only on my forehead. The skin also has begun to roughen and feels tight, but the discomfort level is mild.

Day 17 – My entire forehead is bright red. There’s a little bit of peeling that’s started to happen in the last day or two. I run a few errands in Hyannis and feel a bit conspicuous when I see a friend at the supermarket. At night, when I go with my wife to hear a band at a pub, I wear a baseball cap, which becomes part of my daily uniform when I leave the house.

Day 21 – The last day of treatment. Most of my forehead is still a deep red, but there’s considerable flaking. Sometimes it feels a bit itchy and it still feels like I have a mild sunburn. The skin also feels tight. On a pain scale of 0-10, it’s mostly been a steady 1, occasionally a 2, really just a minor discomfort.

I feel like I have gotten off easy so far, compared to some of the people on a Facebook page for Efudex users. I have nothing that looks like a wound and no side effects, such as headaches or sun sensitivity. But some people who posted on the Facebook page said that their worst reactions happened a few days after they stopped treatment. Turns out my only outing the next few days is a check-in with Dr. Fiske, so I can hibernate if need be.

Day 23 – I have a follow-up appointment with Dr. Fiske. He tells me that I need to think of my entire forehead’s reaction to the Efudex as a wake-up call. I have to be a lot more careful about protecting my skin by avoiding midday sun, be diligent about applying sunscreen and wear UV-protective hats and long-sleeved shirts.

Day 26 – The skin is peeling off. A single layer comes off, bit by bit, in small pieces while I’m watching a Patriots playoff game.

Day 29 – Another layer of skin peels off. The red is fading to a pink.

Day 35 – It’s hard to tell the pink skin from my normal tone. The skin on my forehead feels extra smooth. In a way, Efudex is a variation on the chemical peel that some people get at a beauty spa.

At some point, I need to do the treatment on my cheeks and maybe my nose. I’m not looking forward to it, but I’m not dreading it. It’s just the smart thing to do to prevent AKs from turning into something a lot worse.