What to Know About Efudex for Basal Cell Carcinoma

Skin cancer (most commonly basal and squamous cell carcinomas) is the most common type of cancer in the U.S. There are about 5.4 million new cases diagnosed each year. Of every 10 cases, eight of these are basal cell carcinoma. 

Although basal cell carcinoma is common, it’s also very treatable. Along with surgery and radiation, local treatments like Efudex (fluorouracil) can be used. Below, we discuss how Efudex is used to treat basal cell carcinoma, potential side effects, and a few alternatives.

What is Efudex?

Efudex is a topical form of a common chemotherapy called fluorouracil. Fluorouracil is an antimetabolite that’s used to treat a number of different types of cancer. It works by interfering with the building blocks that cancer cell DNA needs to copy itself. When DNA can’t be copied, a cell can’t divide. This stops cancers from growing.

Efudex is available as a topical solution and cream used to treat precancerous and cancerous conditions of the skin, including basal cell carcinoma.

How does it work for basal cell carcinoma?

Basal and squamous cell carcinomas are the most common types of skin cancers. These occur in the topmost layer of the skin. This top layer of skin (epidermis) is made up of squamous cells in the upper part and basal cells right below. Basal cells are responsible for replacing old squamous cells. 

When cells grow and divide too much, they can form cancer. Cancer that grows in the basal cell layer is called a basal cell carcinoma.

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Since Efudex is a topical treatment, the active drug is put directly onto the skin where cancer cells are growing. Efudex is absorbed and prevents cancer DNA from copying itself within the skin. Cancer cells also grow more rapidly than regular cells, and they also take up fluorouracil more rapidly.

Basal cell carcinomas that are at the surface of the skin and haven’t spread are considered superficial. Superficial basal cell carcinoma can be treated with Efudex. Topical treatments, like Efudex, are typically reserved for people who can’t have surgery or radiation.

Your dermatologist will examine your lesions to figure out the best treatment option. 

How is Efudex given when treating basal cell carcinoma?

When used to treat basal cell carcinoma, a thin layer of Efudex 5% cream or solution is applied to the affected area twice a day. This is continued until the lesions are gone (about 3 to 6 weeks). Sometimes, treatment is continued for up to 12 weeks. This may be needed to fully get rid of all lesions. 

The skin may not fully heal for up to 2 months after Efudex is stopped. After treatment stops, your dermatologist will examine the tumor and how it responded to treatment.

Because Efudex is chemotherapy, it’s considered hazardous. There may be special instructions when you apply Efudex to your skin. This may include wearing gloves when applying Efudex to the affected area or washing your hands after applying it with your fingertips.

Care should be taken when storing and handling the container that Efudex comes in. Make sure to keep it away from children, pets, and other creams.

It’s always a good idea to protect your skin when under the sun and to avoid direct sunlight as much as possible. This is especially important while using Efudex, since it can make you more sensitive to sunlight. Lots of sun and ultraviolet light exposure can raise your risk of new skin cancers, and the basal cell carcinoma coming back.

What are the potential side effects?

Most side effects of Efudex are local. That means that they happen only where it’s applied.

Common side effects

Efudex can cause different types of skin irritation, wherever it’s applied. This can include:

• Burning

• More sensitivity to the sun

• Crusting

• Dermatitis (skin inflammation)

• Itching

• Scarring

• Rash

• Soreness

• Ulcers

At first, skin at the application site may feel sore or irritated, and look a little red. As treatment continues, this may feel worse. Other side effects like burning, pain, or itching start to occur. The skin may then start to crust or ulcer, and later cause scars after the skin heals.

Serious side effects

Since Efudex is applied locally to skin, not a lot of fluorouracil ends up in your blood. But it’s important to note that it may be absorbed more when applied to broken or inflamed skin. This can lead to more side effects. This risk is also greater when Efudex is applied to a mucous membrane (like the inner lining of the mouth or nose), so those areas should be avoided.

Efudex can be harmful to an unborn baby. Tell your dermatologist if you’re pregnant or are planning to become pregnant. You may be required to take a pregnancy test before starting treatment.

What are some alternatives to Efudex?

In cases of superficial basal cell carcinoma, other topical treatments can be used, particularly with low-risk tumors. Like Efudex, these treatments are usually reserved for people who are unable to have surgery. 

These options include:

• Topical imiquimod. Imiquimod (Aldara) is another cream that can be applied to the skin. It works by helping your body’s immune system fight cancer. Like Efudex, it can cause skin irritation where it’s applied.

• Cryosurgery. This treatment works by freezing a tumor with liquid nitrogen to kill the cancer cells. Once the skin thaws, the tumor blisters and peels before healing. This treatment can also leave a scar.

• Photodynamic therapy (PDT). In this treatment, a gel or liquid medication is applied to the skin. A light source is then used to activate it, killing cancer cells in that area. 

One study compared PDT, topical imiquimod, and topical fluorouracil (Efudex). After 5 years, the results showed that Efudex worked just as well as PDT. But imiquimod worked better than both Efudex and PDT. Your provider will help you decide what treatment is best depending on your situation.

How much does Efudex cost?

The amount you pay for Efudex will depend on your prescription coverage and how long you’re using the medication. For example, you can find one tube of Efudex for as low as $69 at certain pharmacies with a free GoodRx discount.

If your insurance doesn’t cover brand-name Efudex, it may cover the generic form of topical fluorouracil. If copays are still high, you can find it for as low as $51 with a free GoodRx discount.

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Written by:

Emmeline C. Academia, PharmD, BCOP

Emmeline C. Academia, PharmD, BCOP, has been a practicing clinical pharmacist in adult oncology since 2020. She is a clinical pharmacy specialist in oncology at Beth Israel Deaconess Medical Center, in Boston.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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