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aldera
Anonymous
Wednesday, March 21, 2007 at 01:44 AMHad a slow growing stickey skin cancer for 10+years on chest. Half-dollar sized. Freeze, Efudex, surgery=no cure and no change. Finally an Aldera course. Now, 4 years later, still no spot.
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aldara
MM
Sunday, April 01, 2007 at 12:51 PMDoes someone have an answer? Is it OK to use makeup and sunscreen lotion when you go out while you are using aldara 2 nights a week for 4 months?
I'd appreciate any info you might have.
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Carcinoma in situ VIN III, Severe squamous dysplasia
Esra
Friday, May 25, 2007 at 09:15 PMDr Berman,
I have just been diagnosed with above in the vulva. I have been given Aldara to use for the next 2 months. Have done some research and found some terrifying information as well as good. There is a website Aldara1.com which 3M tried to take down but lost. Also 3M Pharmaceuticals settle a lawsuit outside of courts for a man who got extremely sick. Please advise how come Aldara is being prescribed? If this is true how can doctors play russian rullet with the public? Please help
re: Carcinoma in situ VIN III, Severe squamous dysplasia
glad to serve
Thursday, July 24, 2008 at 01:27 PMI was talking to the various pharmaceutical companies and I learned that once a drug is FDA approved a doctor can use it for anything he/she chooses to prescribe it for. I too am suffering greatly from misapplication of a drug. Efudex is labled specifically not for intravaginal use. My doctor said "trust me, I know what I am doing". Six months later, suffering from chemical vaginitis and chemically induced cystitis as confirmed by cystoscope I asked my gynocologist if they still stood by "trust me". I was told that the urologist has a right to his opinion but the gynocologist still feels it is perfectly safe. I wish I could trade bodies with that doctor for one day, so they could experience what they are so coldly dismissing. This is extremely painful, unnecessary and has put the breaks on all of my personal plans since February.re: Carcinoma in situ VIN III, Severe squamous dysplasia
Anonymous
Saturday, August 08, 2009 at 01:03 PMI don't think it is Russian roulette.. everybody is different in how they react to the treatment..I used Aldera for 4 months ,I must admit it wasn't the nicest experience I have ever had but It looks like now that the black scabs have all gone all my skin has to to is heal from the redness from being raw. I am happy that that part is over with now I have to deal with my nose and hopefully same thing will happen and I can get back to being me again,also the vulva is a much more sensitive area just dab small amount on
Skin cancer is as my derm said from a lack of using sunscreens and basking in the sun or using the tanning salons.As I told him when we were young it was baby oil and iodine and that basically cooked our skin~~even after so many terrible burns it took me until my late 20's early 30's to smarten up, although I used it for my kids I never put it on religiously....The derms do as much as as best the can to treat everyone and hopefully help them with thier problem I hope this helps you~~~if you have aldera USE it I am not sorry at all and I didn't have much problems ohhh maybe a tiny bit of hair loss but that I think was because I was on it for so long it is basically a chem tratment by cream..Good Luck!
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Aldara
Anonymous
Tuesday, June 26, 2007 at 06:11 PMHave been treating my face and chest for3+ weeks 2x's week with Aldara. Have large open oozing sores, diahreah for 3 weeks and horrific flu like symptoms for 2 days after each treatment..pins and needle feeling throughout my body, joint and muscle aches with slight fever. I have been megadosing vitamin c thinking I was getting a flu. Curios about these symptoms I researched Aldara on line and was horrified to read how dangerous it can be. Many people including physicians are trying to get this off the market.re: Aldara
Anonymous
Wednesday, September 10, 2008 at 11:36 PMI have treated literally hundreds of squamous cell in situ skin cancers and actinic keratosis with Aldara with great success. There are a very few people who will have severe reactions to using Aldara topically, but generally when someone has a severe systemic reaction this happens for one of two reasons. 1. They apply the entire package of Aldara to a single small skin lesion when with most small lesions a single packet contains enough medicine for 8-12 applications. Just take a bit of tape and close up the packet to save the remainder until time for the next treatment. (2) People can have a severe reaction if they get any Aldara on a mucous membrane or inside the edge of their nose or in their eye. In this situation Aldara can rarely cause flulike symptoms caused by a cytokine cascade creating temporary high levels of interferons, ILs and NKCells that causes the flulike symptoms. This can be a little scary but unless you stick an entire packet up your nose you will quickly recover. Some tylenol or ibuprofen will make you feel better if this should happen to you. Also call your Dr.
I think Aldara is a miracle drug compared to having to get repeated excisions of skin cancers. I also like being able to tell if a lesion is probably malignant due to the reaction created by applying Aldara. If there is no reaction then the lesion is not likely to be skin cancer but something else. Then you need a biopsy to find out what is going on. In my personal experience Aldara works better on SCC than on BCC. There is a learning curve to figuring out how best to use Aldara and I am sure there arer plenty of Drs who do a poor job of telling the patient what to expect, but once you figure out how to properly use this medicine it can save you a lot of cutting and scars plus you can treat small lesions as soon as you suspect a skin cancer rather than having to wait for an excision and the pathologist report.
re: re: Aldara
Stephen
Thursday, September 24, 2009 at 10:29 PMDear Anonymous,
Your description of Aldara is perfect. I had Mohs surgery on my scalp for a squamous cell in situ. After the Mohs surgury I used Aldara for some actinic keratosis. The first four weeks nothing after five weeks the Aldara started to work. The last weeks of my Aldara treatment were rough but three weeks after I finished my treatments my skin was smooth and clear. I am confident I could have beaten the squamous cell in situ skin cancer without the Mohs surgery but the Aldara was not mentioned. To anyone with a skin problem go on the internet and learn about your problem and choices and talk to your doctor. I wish I did research before any choice.
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Efudex as Vaginal Cancer treatment
LMA
Thursday, August 23, 2007 at 01:31 AMI am starting this treatment soon for vaginal pre-cancer. Any tips. I am scared of the pain i have been warned about.re: Efudex as Vaginal Cancer treatment
Robyn N.
Thursday, September 20, 2007 at 09:52 PMIt is a horrendous treatment. I went hrough six treatments before having to stop, pain, nausea, burning. First get a second opinion from a gyno-oncologist. My second opinion oncologist said he has not used this drug for 15 years, that the treatment was way worse than any cancer. Stop, run and seek a second opinion.re: re: Efudex as Vaginal Cancer treatment
Linda
Saturday, December 08, 2007 at 09:59 PMJust the opposite for me. Absolutely no problems. I read on another website to use petroleum jelly on the outside skin area in case of any burning. Very very rarely did I feel burning, and when I did, I used the jelly and had absolutely NO problems. I was scared to death to use it after reading all the "stories" on the Internet, only to find out I had absolutely nothing to fearEfudex as Vaginal Cancer treatment
Marlena
Saturday, December 29, 2007 at 03:06 PMre: Efudex as Vaginal Cancer treatment
Marlena
Sunday, January 06, 2008 at 10:08 AMUpdate: I completed my 7 days of therapy. Used Zinc Oxide on outside and no burning but the damage on the inside is horrendous. Since stopping, my vaginal opening is sealing up. Nothing is stopping it. It is painful to reopen. Bath after bath to give myself relief from dryness and pain. I don't want to do the next treatment. I am scared to death. I don't know what the final healing from this course of treatment will be. Any pointers from anyone on relief or how to stop this closure from happening?re: re: Efudex as Vaginal Cancer treatment
Janice
Friday, January 18, 2008 at 07:33 PMI went through this nine years ago. The pain is no fun. I used the petroleum jelly even around the opening. The best way I found to insert the applicator with all the raw flesh is that I put just a little bit of lubricant on the tip of the applicator, put one foot up on the toilet seat and inserted it as fast as I could.
After all is said and done, it wasn't fun but I have not had one irregular pap since, and I battled cancer for years, had a hysterectomy, went through interferon injections, laser and I finally got relief after this treatment.
re: re: Efudex as Vaginal Cancer treatment
glad to serve
Thursday, July 24, 2008 at 01:16 PMEfudex is a dangerous product with serious complications. http://www.getoomph.com/pdfs/EfudexPatientBrochure.pdf Read page three of this link and you will see that the company warns against intravaginal use due to vaginal necrosis, ulcerarations, and other local reactions. I can personally tell you that it does not target bad cells. It affects and kills every cell that it comes in contact with. I can see where it is entirely capable of sealing off a vaginal opening. The best thing you can do is keep vaseline or neosporin on the affected area. Once all the tissue is killed off, the body's natural healing process will seal together raw tissue. I personally underwent this treatment without a full understanding of how much damage it would do. It caused me to suffer from intense pain and swelling due chemical vaginitis. I also have suffered from chemically induced cystitis according to the cystoscope performed by my Urologist. EVERYONE should know that this drug is so dangerous that the FDA gave it their Box Warning:High Alert Medication: "The Institute for Safe Medication Practices includes this medication among its list of drugs which have a heightened risk of causing significant patient harm when used in error." This is copied from the Merck Manual website. This drug is supposed to administered as a last option and only by a physician trained in the safe use of this drug. I began treatment intravaginally in February and I am still suffering greatly. Never trust a doctor who tells ou that even though the box says specifically NOT FOR INTRAVAGINAL USE, that they know what they are doing and it is perfectly safe. It is not safe! That is why all these warnings are posted on the internet. Click on this link to find out about studies on the success rate of this treatment. The study shows that folks on placebo had a higher recovery rate than those on Efudex intravaginally. Why? Most likely the weakened tissue was more susceptble to dysplasia/virus cells. http://www.hindawi.com/getarticle.aspx?doi=10.1155/s1064744999000319
re: re: re: Efudex as Vaginal Cancer treatment
Anonymous
Monday, October 27, 2008 at 06:22 PMI am in week 4 of efudex treatment for vaginal dysplasia and, like you, have had no problems. Did you apply petroleum jelly before insertion of the cream or after or just when you had any burning. If I get a tinge of burning upon urination, find that if I drink lots of water I do not have it. Just curious if you are still having normal colposcopies or have any problems recurred?
re: re: re: re: Efudex as Vaginal Cancer treatment
Anonymous
Thursday, November 06, 2008 at 10:16 AMI used efudex a few months ago with no results--good or bad. But wanted suggest that if you have a tight or narrow vagina, you might want to ask your MD about using a vaginal dialator. My vagina was extremely tight (due in part, and most unfortunately, to lack of use) which resulted in very painful gyn exams. So finally my gyn/oncolgy MD gave me an extra small and a small vaginal dialator. Having worked my way up to the small size, I now find that the use of the small speculum is no longer painful (never mind the biopsies and other insults to my integrity). I hope that this will be of help.
Lisa
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Carac Cream
jimbo61
Sunday, September 09, 2007 at 08:39 PMI am on day 10 of 2X day Carac Cream for AK's on my face. Not a terrible reaction yet. I hear that the third week is the worse. What is the difference between Effudex and Carac?? -
painful!
Amanda
Friday, January 18, 2008 at 10:20 AMI've been on the treatment for about two weeks now, taking it 3 times a week. For the past week, I've woken up with insane itching around three or four in the morning every morning. It's getting to the point where I'm having trouble going to the bathroom and for the life of me can't ignore the problems this is causing me. I can deal with a lot, but it's beginning to be very bothersome. Anything I can use to help the pain/itching? I tried to call my doctor this morning, but after three failed attempts and the fact that I can't afford a doctor's visit [thanks to having no insurance!] I'm not sure what else to do.re: painful!
Amanda
Friday, January 18, 2008 at 10:21 AMre: painful!
Anonymous
Wednesday, September 10, 2008 at 11:40 PM -
Untitled Comment
laura holt
Thursday, February 07, 2008 at 09:35 PMI am currently using aldara and it is not easy. It is painful after 3 weeks of using it 5 days a week. the areas on my face where I am applying it look horrible, and I have to work everyday,it is difficult, really hard. I have had skin cancer for over 20 years and I am 47. I have used effudex, have had mohs surgery. It is really difficult, but I keep thinking I will be done with this soon and then I will look normal for a while. I realize many people have many serious health issues, but sometimes this really gets me down. Please everyone, just try to get through every day.re: Untitled Comment
Rebecca
Sunday, February 10, 2008 at 11:42 AMLaura - I hope your weeks of treatment go fast for you. I am facing the decision of either doing Mohs or Aldara for a bcc on the side of my nose. If it weren't in the middle of my face it would be easy to pick surgery and just have a scar somewhere. But because it would be in such an obvious place, I am thinking that maybe I should try to live though the Aldara for 8 weeks and not have to live with a scar for the rest of my life. Why if you have done surgery in the past did you pick Aldara this time? Do you regret it? Am I going to better off with just doing the surgery? Any advise would be appreciated! Rebre: re: Untitled Comment
jen
Thursday, September 03, 2009 at 04:22 PMre: Untitled Comment
upc
Saturday, June 14, 2008 at 12:28 AMI began aldara three weeks ago, I have taken breaks during that time when I did not use it, and now I have stopped forever. I had a tiny cancer on my chest so small that even the dermatologists really didn't know where it was. But I really didn't want the surgery, so thought that using aldara was the perfect answer. Now I am so sorry that I let anyone do anything, my whole upper chest is a mass of open sores, I'm putting neoporesporin on it, I have to cover it during the day, it bleeds and sticks to my shirt, I leave it exposed at night, but it doesn't seem to be healing. I'm 76 years old, have arthritis, but am otherwise healthy. Do you have any advice for me? I see my primary Dr. in a week, and the dermatologist who prescribed this in two weeks. I'm so sorry that I ever used this ---I was fine before...thanks for your help.
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How u use Aldera is the Key
Pamela Hook
Saturday, February 23, 2008 at 01:28 PMI decided to use Aldera on my lip line which constantly was lined w/ dry, flakey skin. No matter what I did it wouldn't go away. My son was using Aldera for warts on is foot. I figured since warts are started by a virus like cancer it might work. The medicine is very expensive so I thought it was worth a try. When I first started putting it on at night an ugly spot popped out. This was my clue to ease off on the medicine because I felt this spot meant the medicine must be eating away at the cancer or pre-cancer. Then I determined I should Keep it clean w/either alcohol or proxide so as not to get the wound infected. After dry, I followed up w/ Neosporin Antiobiotic w/ pain relief ing. Let it rest a few days before putting on more Aldera. Kept repeating the process & before you know it all dryness is gone. Before this treatment all I could think about was how I would be disfigured for life w/ surgeries on my lips. The spot also cleared up perfectly. When applying Aldera you must be careful to only apply to the affected area. If not careful it can leave a little white spot.So don't use more than you need to and wash your hand after applying. Sometimes I dot it on w/ a Q-tip. I also used it on a spot which had been surgically removed by a plastics doc. He was careful not go too deep but it didn't get it all. I followed up and its all gone. Please don't do this stuff without checking w/your doc. You have to make sure that its not melonoma. It' is a deadly cancer which requires more rigorous treatment and you need to be under a doctors care. One more note of caution. If you use Aldera, cover up the wound if its going to be exposed to the sun. This is why I apply at night. Good luck.re: How u use Aldera is the Key
quijibored
Wednesday, September 10, 2008 at 11:56 PMYou are correct. Most people who have problems with Aldara either do not receive proper instruction beforehand or are not told that the skin lesion to be treated can get real ugly before it heals. I have treated numerous squamous cell skin cancers on my forearms that were about the size of an eraser tip before starting Aldara treatment but they reacted so strongly to the Aldara that within a couple weeks it made a big crusty scabby sore about an inch in size. The good news is that when you have a big reaction like this it means your immune system is reacting strongly to destroy the cancer and once you have a significant reaction going on for about a month you can just quit treating with the Aldara and let the lesion heal up. It may take a month or longer for the scabby crust to heal and the scab to fall off but then the skin heals properly and without scarring.
It does take some getting used to seeing this big scabby sore on yourself but you have to trust that the medicine will work and for me it almost always does and always heals up if given enough time. There are a few basal cells or squamous cells that for whatever reason will not respond completely or quickly enough - within 2 - three month courses of Aldara and then I go ahead and have the remaining lesions surgically excised but most of the time the Aldara works just fine, often in a month or less rather than the predicted 2-3 months of therapy.
re: re: How u use Aldera is the Key
Stephen
Thursday, September 24, 2009 at 10:44 PM -
This is the cheapest aldara?
Chan
Monday, March 10, 2008 at 01:18 AMI find the website that sell the aldara online which i buy it alrady. It very cheap Aldara 5% cream (imiquimod) 12 sachets by 3M Pharma only 140US$ at http://www.edrughouse.com/catalog/main_product.php?cPath=30
I attempt to find the cheper, if some one in site can find, please told me too.
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Untitled Comment
Anonymous
Tuesday, October 28, 2008 at 09:18 AM -
Aldara online
William
Tuesday, October 28, 2008 at 12:09 PM -
Choices of treatment for BCC
Sue
Sunday, December 28, 2008 at 09:46 AMFor a small BCC there are also other options, even for the face. Radiation, and burning it off. Burning leaves a white patch where the BCC was, so it may not be for everyone. But, Mohs also changes the original appearance and leaves a scar. I would have chosen to burn mine off my nose had I known that Mohs would cut my nose the entire length from eyebrows to between the nostrils, and leave me with a different shaped nose. The BCC was shallow (one Mohs slice removed it) and small. Mohs was overkill. People worry too much that BCC is 'cancer'. It is slow growing and non-malignant. Stay calm and definitely try Aldara first. Once the course if done, there is no scars or aftermath.
Sue
re: Choices of treatment for BCC
dianacuttrell
Thursday, April 16, 2009 at 01:21 PMI am a 52 year old woman who has been active all my life, surfing and horse back riding with lots of sun exposure.
I had a BCC on my lip for years and treated it with Aldara and Efudex, I don't think I did the treatment correctly and the BCC never went away only got larger. I had Mohs surgery done in late November '08 and am still recovering from it. It was very traumatic and I was unaware that I would have stitches starting from the side of my nose to the corner of my mouth. My surgeon did a fantastic job, but I still have swelling and some discoloration. I am currently being treated with a Vbeam to remove the redness. The good news is that BCC is gone, the bad news is I am not completely back to normal still having numbness and swelling along with the discoloration.
Since the surgery, two smaller BCC's have surfaced, my surgeon, wants to remove them with Mohs surgery (again), my dermatologist wants to treat less aggressivily. From reading the comments on this site, I want to try the creams instead of surgery, With Mohs there would definitely be huge scars, one is under my eye and the other on the right side of my nose. I can't bear to go through the surgery again and I am very scared.
From reading other's results using the cream, I will give it a try and be extremely diligent with the directions on how to use it correctly. Any comments would be appreciated.
re: re: Choices of treatment for BCC
DH
Friday, May 01, 2009 at 06:18 PMI'm also 52 and was diagnosed with BCC on my nose (top and towards tip) almost 8 weeks ago now. Have been using Aldara 3X week as prescribed by my dermatologist (He said to use a very small amount...that more is NOT better. He also warned me that it would eventually look 'hideous' for a while, but that that was better than the alternative.) Well, I've had no side effects at all other than itchiness (tolerable) and a slight burning nights I use it. My doctor was right- it looks absolutely hideous and for the past 2 weeks I try to just go to work and not run too many errands as I'm very self-conscious about it. My 8 weeks is up this Sunday and I go back to the dermatologist this coming Tuesday. If the Aldara has worked, it will have been worth it...much better than a scar (and I'm hoping this big ol' scabby thing doesn't leave a scar...)! Good luck and remember to use a SMALL amount-
re: re: re: Choices of treatment for BCC
Giacomo
Sunday, September 20, 2009 at 01:14 AMI've used Aldara and Efudex for 'Years' due to having Gorlin-Goltz Syndrome = Hundreds of Basal Cell Carcinoma's all over my body. If you 'Use as DIRECTED' you will not have problems UNLESS you're 'Allergic to the product' like any other product or food, etc. It's life folks! I know of people who 'Used TOO MUCH Aldara, when they were told to use A VERY SMALL AMOUNT, like the end of a Ball Point Pen! People do not listen and do it there own way, think using MORE is better (it is not - ever) and suffer the consequences. Creams are better than surgery! Duh!
You will have 'some minor redness for months. Maybe even years. Slight. Unless you're a Narcissist don't worry the redness is very minor. I use to have perfect skin, but played tennis 8 hours a day for 30 years and surfed and ran on the beach daily, where I grew up. I am loaded with SKIN CANCER NOW! Plus, I had no idea this rare skin cancer 'Genetic Problem' runs in my family. My God. Use the Cream when you can. Far better than surgery or freezing. Cryosurgery leaves permanent 'scarring too' The pigment of skin is forever damaged. USE THE DAMN CREAMS AS DIRECTED AND ALMOST ALL PATIENTS WILL BE FINE. 24 years of experience telling you this! Former Semi-Pro tennis Player - Malibu, Calif. -
Chelitis Glandularis aldara vs carac
Anonymous
Thursday, January 22, 2009 at 01:08 PMI was diagnosed with chelitis glandularis. I tried carac for a month with few results. Doctor now suggests Aldara. What will the difference be?
re: Chelitis Glandularis aldara vs carac
Jellybean
Monday, July 13, 2009 at 02:19 PMI am using Cara for warts on my hands and after 1.5 weeks, I see noticable areas where the wart disappeared. Carac is great for these. I use quite a generous amount and put gloves on, then go to sleep. I tried Aldara on one hand and it is vicious. It eats away at the wart leaving an ugly sore. Must not use too much at a time, and stop if the sore is getting bad.
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I used this cream successfully
AJ
Monday, February 23, 2009 at 04:03 PM -
Aldara side effects
Jennifer
Saturday, March 28, 2009 at 01:50 PMHi, I was just prescribed Aldara to treat 27 BCC lesions in various areas on my upper body. This is my 3rd round with it - the first two times it was prescribed (years ago, for just one lesion) completely failed; the cancer returned within months. My doctor prescribed it this time due to the number of lesions I have, which requires a LOT of Aldara each evening. Don't believe that there aren't systemic side effects - by day four I had completely lost my appetite, had become listless and tired, and can hardly lift my arms due to swollen lymph nodes. All of that in addition to the painful sores at the site of application. It's a SERIOUS drug! Expect side effects and be careful using it.
re: Aldara side effects
Giacomo
Sunday, September 20, 2009 at 01:23 AMIf your doctor is prescribing this for use on 27 BCC or ANY skin cancer 'You should consider changing dermatologists'. My God, this is insane! It is NOT for use on 'More than 'One REGION at a time'. You are putting so much TOXIN in you it is funny. 'Of course, it'll take longer to get them ALL but, using this on so many (27) at one time is 'Not the right treatment Regiment/Protocol'. Call 3M and ask them. NOW! and then get a 'Second Opinion' ASAP. ALDARA ON 27 BCC ALL AT ONCE??? I cannot believe I just read this! I am sick over it.....CALL ANOTHER DERM ASAP.
PLUS, WITH SO MANY BCC (YES, I HAVE HAD HUNDREDS AND HAVE BEEN FIGHTING BCC'S FOR 24 YEARS, SO YES, I DO KNOW. I'VE HAD 34 DERMS AND MD'S) YOU SHOULD TRY 'A COMBINATION OF THERAPIES' AS I AM....PHOTO-DYNAMIC THERAPY, ALDARA, EFUDEX, MOHS (WHEN NECESSARY), CRYOSURGERY, AND MORE....YOU NEED TO READ AL YOU CAN AND TAKE CARE OF YOURSELF. IT IS YOUR BODY! 'KNOWLEDGE IS POWER' AND IT MIGHT JUST SAVE YOUR LIFE.....27? I cannot believe you're applying aldara to ALL of them!
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Non-Melanoma Skin Cancer Creams
Cardinal
Saturday, April 11, 2009 at 06:52 PMHas anyone on this forum ever used CYMILIUM or CURADERM for treatment of skin cancer?
Do you think these products would work?
http://www.cymilium.com/SkinCancer.html
http://www.curaderm.net/technology/diseasestreatablenmc.aspx
re: Non-Melanoma Skin Cancer Creams
Anonymous
Wednesday, May 13, 2009 at 08:54 PMI've used cymillium, but not with much success. I have now undergone one Moh's on my face and am using Aldara on my chest. Check out topicalinfo.org for lots of great info on these and many other alternative skin cancer treatments. Especially check the forums for many personal experiences. Good luck and God bless.
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Bloody Murder
Bryon
Monday, November 16, 2009 at 12:59 PMAldara should be called "Bloody Murder" so that patients will know what to expect from it. I used it exactly as directed, only a tiny bit on a q-tip rubbed on the spot of basal cell carcinoma. Next day the spot was red and my body ached all over. The second day the sore was worse and oozing. After four days I couldn't stand the pain and discontinued. The spot on my face now looks like I was blasted by a 12 guage shot gun with blood and puss coming out. Since I stopped using Aldara most the body aches have stopped, but I feel pressure in my head and an ache in my neck.
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5-fluorourcill
S Long
Tuesday, November 24, 2009 at 02:22 PM
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