Q. I grew up on the coast of North Carolina spending way too much time in the sun. I now have numerous scaly spots on my face and recently had a skin cancer removed. I have read about a cream that can be applied to the face to remove some skin cancers and the scaly spots on the face. Do you know anything about this? The cream is called Efudex.

A. I am familiar with this cream, although it is usually prescribed by dermatologists. Efudex or Fluorouracil is a drug that has many uses, but when applied to the face in cream form will create a very significant inflammatory response. Fluorouracil is a chemotherapy that when used on the skin will cause cells that are growing the fastest (skin cancer) to die and then slough off. Fluorouracil has its best results on actinic keratosis (scaly lesions) and superficial skin cancers. It may not work for skin cancers that are deep in the skin. It is important to use the cream exactly as prescribed to get the best results. It is not approved for use if you are pregnant. You must be prepared for the inflammatory reaction that will occur during the treatment time. The face will get very red and the areas of fastest skin growth (skin cancers or benign scaly lesions) will often develop into a sore that may weep and will form a scab over the lesion. The second week of the treatment is often the worse in terms of redness and sores on the face, and it may take several weeks for the skin of the face to completely recover. You must remain out of the sun as much as possible during treatment since your skin will be much more photosensitive during the inflammatory response. The more sun damage that a person has, the more reactivity of the skin will occur. If there are any residual suspicious areas left on the skin after treatment, that may indicate that the lesion was too deep to be adequately treated by the Efudex and the dermatologist will evaluate for possible biopsy. I would suggest you be evaluated by a board-certified dermatologist to make sure that you are a good candidate for this treatment.