Chemotherapy cream kills cancer cells on or near the skin’s surface when applied to the skin. It can be an effective alternative to surgery, but only for certain skin cancer forms.

Chemotherapy cream is an anticancer treatment that you apply directly to the skin’s surface. This is called topical chemotherapy.

Topical chemotherapy kills cancer cells in the skin. People commonly use it to treat precancerous lesions and skin cancer affecting the top skin layers.

This article explores how topical chemotherapy works, why people use it, and its potential side effects and effectiveness.

Chemotherapy cream is a topical chemotherapy drug that you spread directly onto the skin. Once applied, the cream kills cancer cells on or near the skin’s surface.

However, the cream doesn’t reach cancer cells in deeper skin layers or other body parts. Doctors refer to it as a localized treatment because of this.

The most commonly prescribed chemotherapy cream is topical fluorouracil, also called 5-fluorouracil (5FU). It’s available as several brand-name drugs:

  • Carac
  • Efudex
  • Fluoroplex
  • Tolak

Other topical drugs used to treat skin cancer include:

  • tirbanibulin (Klisyri), a chemotherapy ointment used on the face or scalp
  • imiquimod (Aldara, Zyclara), a cream that clears cancer by boosting the body’s immune response
  • diclofenac (Solaraze), a nonsteroidal anti-inflammatory gel

A doctor must prescribe these medications. Your doctor can discuss which treatment options may be right for your skin cancer.

People usually use chemotherapy cream to treat precancerous skin growths called actinic keratosis.

Actinic keratosis usually forms on skin areas exposed to the sun, such as the face, scalp, hands, or chest. It’s more common in people with lighter skin tones.

Along with chemotherapy cream, doctors may prescribe the drug calcipotriene, a synthetic form of vitamin D, to help treat actinic keratosis and shorten the treatment length.

People may also use chemotherapy cream to treat superficial skin cancer. The term “superficial” means the cancer affects only the skin’s surface and hasn’t spread to deeper skin layers or other body areas.

The most common skin cancer type treated with chemotherapy cream is superficial basal cell carcinoma. Some people might use certain topical chemotherapy medications to treat other cancer forms, such as Bowen disease.

In addition to chemotherapy cream, other localized treatments for actinic keratosis or superficial skin cancer include:

Your doctor can show you how to apply the cream so you can do it at home.

It’s important to follow your doctor’s specific instructions. This can ensure you apply the proper cream amount and avoid skin irritation.

Generally, you can also follow these steps to apply the cream:

  1. Wash your hands with soap and water.
  2. Apply the cream to the affected area using a glove, nonmetal applicator, or your finger.
  3. Rub the cream into the skin and allow it to disappear.
  4. Rewash your hands.

Do not apply the cream near the eyes, nose, or mouth. Also, avoid wrapping the skin or applying a bandage unless instructed by your doctor.

How often and how long you apply the cream can depend on the medication you use and which skin cancer type you have.

For treating actinic keratosis:

5FUonce or twice per day2–4 weeks
diclofenac (Solaraze)twice per day 2–3 months
imiquimod (Aldara, Zyclara)once per day for 2 days a week16 weeks
tirbanibulin (Klisyri)once per day5 days

For treating superficial basal cell carcinoma:

5FUonce or twice per day6–12 weeks
imiquimod (Aldara, Zyclara)once per day for 5 days a week6 weeks

These are only general guidelines based on typical usage. Always follow your doctor’s instructions and the directions on your prescription label.

After applying chemotherapy cream, you may experience minor pain, dryness, or soreness at the application site.

Additional side effects may include:

  • a burning sensation
  • crustiness
  • swelling
  • a change in skin color
  • irritation
  • itchiness
  • rash

Serious side effects are rare but may include:

  • bloody diarrhea
  • vomiting
  • fever
  • chills
  • a severe discolored skin rash or abdominal pain

Speak with your doctor if you experience side effects that are severe or don’t go away.

What does your skin look like after applying chemotherapy cream?

Your skin will appear red and inflamed after you apply the cream. The area may also be sore and leak fluid. You should protect your skin from the sun as it heals, as the sun can make the inflammation worse.

Contact your doctor immediately if you experience severe, prolonged, or concerning side effects. They can pause or stop treatment. They may also prescribe a steroid cream to help with the inflammation.

Your skin should heal fully within 1–2 months.

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Topical chemotherapy may be an effective treatment for precancerous lesions such as actinic keratosis. It may also be effective for certain superficial skin cancers, though research shows some drawbacks.

Here’s what current research suggests:

  • A 2015 study found that a single course of 5FU effectively reduced actinic keratosis for more than 2 years.
  • A 2016 study suggested that combining 5FU and topical calcipotriol can effectively reduce or eliminate actinic keratosis.
  • A 2017 study compared imiquimod and 5FU effectiveness for treating superficial basal cell carcinoma. After 5 years of treatment, the likelihood of tumor-free survival was 80% for people treated with imiquimod and 70% for people treated with 5FU.
  • A 2013 research review examined using topical chemotherapy for nonmelanoma skin cancer. With 5FU, cure rates were 61–92%. With imiquimod, cure rates were 65–100%.
  • A 2021 review concluded that 5FU can be most effective when combined with other anticancer treatments. However, chemotherapy can cause drug resistance to 5FU, limiting its effectiveness. Researchers are investigating ways to overcome this drug resistance.

Topical chemotherapy is an anticancer medication applied directly to the skin. It may cause minor pain and discoloration, but these side effects should resolve as your skin heals.

Although surgery is a standard first-line skin cancer treatment, topical chemotherapy can be effective for precancerous growths or early superficial skin cancer.

Effective skin cancer treatment may require various options, including surgery, chemotherapy, and localized treatments such as topical chemotherapy. Talk with your doctor to discuss the right options for you.