This is my story of treating some actinic keratosis on my bottom lip in the fall of 2018. I’ve had several “pre-cancerous” or “suspicious lesions” froze off and even have a 2″ scar on my abdomen of the pencil eraser sized spot they had to remove, and then come back to cut more out when the margins weren’t enough. So I am not stronger to skin cancer scares. This treatment was different. Longer and a little more painful. Use sunscreen people. Every damn day.

Growing up in the sunshine state of Arizona, as a redhead with naturally fair skin, skin cancer seems inevitable. It’s not a matter of “if”, more like “when”. Every trip to my dermatologist (6 month intervals) has him cutting or freezing something off. This last trip, I asked him about my lips – specifically my bottom lip. For the last 4-5 months it has been in a constant state of chapped; dry and cracking, bleed than peel. In that order, just cycling through. I’ve tried all sorts of lip balms, mask, coconut oil, and it still cycles through. 

 Actinic Ketosis – pre-cancerous lesions – and he pulled out his little silver can and froze a spot. “That should take care of it, but if it starts to flake again we’ll want to treat it with Efudex cream. Maybe in October because it makes for a gorey Halloween costume”. Sounds fun. So of course when the flaking came back, I did some research on the old internet and completely panicked. This is nasty. But here I am. I was prescribed fluorouracil 5%, directions to apply a thin layer to my bottom lip every night for 7 days. And then stop. 

Here’s what I didn’t know when I started – fluorouracil builds up, so each application adds a little more. Don’t expect a reaction right away, or even after a few treatments. I was expecting a big reaction – swelling, skin peeling off, Bloody oozey lips after the first two treatments. By the 5th treatment, I still didn’t have much of a reaction. My lips were a little red, and maybe slightly swollen – they felt like I had a bit of a sunburn. Nothing I couldn’t live through. Then day 6 had me a little worried. Day 7 it was hard to talk, my lips were starting to sting all the time, and were red and swollen. Day 8 – I didn’t have to apply the medication which was a relief because I couldn’t go more than 2 hours without applying some sort of lip moisturizer. By day 9, the oozing began. 

Fluorouracil works by preventing abnormal cells from dividing, when cells can’t divide they die. As the medication builds up in the cells, they can longer live, and start to slowly die off. This causes the initial inflammation and then the death of tissue. This is what I refer to as the nasty oozing stage – the precancerous stuff is dying, and that’s the reaction. It hurts. Sleeping is impossible for longer than 2 hours, because the Vaseline is absorbed and the lips become dry and start burning again. 

Day 10 and 11 the dead tissue has started to peel away, because I’ve kept the area moisturized, it’s less like flaking skin and more like ooze. And when I speak, the dead ooze sticks to the upper lip and pulls off. This is not a pleasant sensation. If the tissue starts to dry out, it gets crusty (not unlike a scab) and is beginning to crack and bleed a little. These are good signs, I’m laying down fresh healthy tissue under this mess. I’ve gotten subs for my classes the last three days, because talking is painful. If I didn’t sweat and talk while I worked, I’d probably be able to work through this stage. The other positive here is that no one seems to really notice the yellow crust that is my bottom lip. Or if they do notice, no one has said anything or even stared at it.

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Chances are I will have to use efflux again, probably not on my lip, but on another area. I have had other pre cancerous lesions burned off, and even cut out. In the meantime, I’ve complied a list of things I found helpful during my experience. I’d also like to point out, that for my first time, I probably got off lucky. I have heard stories of people who have undergone the same treatment, but more aggressively; applying the cream multiple times a day for many more days than I did. And in other body area – the entire face, the neck and chest, back of hands… I can just imagine how uncomfortable a bigger treatment area would be!

Wear sunscreen every day. And make sure your lip balm has sunscreen. Wear sunglasses with polarized lenses. Don’t forget to put sunscreen on your ears and back of head. Wear sunscreen even when it’s cloudy. Avoid direct sun exposure when possible, and make sure you wear sun protective clothing when you are outside. And if you really need a tan, the science has come a long way with self tanners – its safer.

Helpful hints:

Advil – pain management and anti-inflammatory

Cold compress – either ice packs, or even wet frozen paper towels, feel amazing and takes some on the sting out of the burning sensation and helps the inflammation a bit.

Aquaphor and Vaseline – I found it worked best when I alternated the two. But applied every 2 hours, or more frequently if you are eating and talking. Basically, never let the area become dry. Dry equals pain. 

Drinking straws – the less stuff touches your lips the better. Even food should be cut into bite sized pieces for consumption. 

Face Mask (for sleeping at night) – yes, the SARS kind. During the treatment phase, this keeps the medicine on your lips and off your pillow cases. And during the oozing phase, it contains the ooze and keeps it off your pillow cases. Also, the mask prevents the Vaseline/Aquaphor from drying so quickly (more time trying the sleep)