Getting Topical Chemotherapy
While many types of chemotherapy (chemo) are given by infusion or injection, there are also types of chemo that are rubbed on the skin. Usually, these come in a cream or ointment and are applied directly to the site of the cancer.
- What is topical chemo?
- How often will I need topical chemotherapy?
- How and when to use topical chemo
- Will I still need to see my doctor if using topical chemo?
- Special handling for topical chemo
- How long does topical chemo stay in the body?
- What are the side effects of topical chemo?
- Questions to ask before starting topical chemo
What is topical chemo?
Topical chemo is chemo that comes in a cream or ointment that is rubbed onto the skin. It is used most commonly as a non-surgical treatment for certain types of skin cancer, such as basal or squamous cell, or precancerous changes, such as actinic keratoses. Because the chemo is only applied to the skin, it doesn’t spread throughout the body, so it doesn’t cause the same side effects as systemic chemotherapy (treatment that affects the whole body). Examples of topical chemo include 5-fluorouracil (5-FU) and tirbanibulin (Klisyri).
How often will I need topical chemotherapy?
You may need topical chemo treatments once or twice daily for a period of days to weeks. Your cancer care team or dermatologist will tell you how often and for how long to apply the topical chemo.
How often you use topical chemo and how long your treatment lasts depend on:
- The kind of cancer
- The goals of the treatment
- The chemo being used
- How your body responds to it
How and when to use topical chemo
Most often, topical chemotherapy comes as a cream or ointment from the pharmacy, and you apply it at home. Your doctor or pharmacist will give you specific instructions for how much to use, where on your skin to apply it, and how often. Be sure to follow the instructions on the label about how to use the medication. Wash your hands before and after use.
The success of topical chemo taken at home depends on you—it’s important to take the right dose at the right time, just as you’ve been told. Your cancer care team is there to help you do this.
If you miss a dose or are late taking one, tell your doctor or nurse about it. They need to know about this when deciding if treatment is working. It may also help the doctor decide whether to change how much of the medicine you take or when you take it.
Will I still need to see my doctor if using topical chemo?
Even though you apply topical chemo at home, you will still need to see your cancer care team. They will:
- Watch for changes in the cancer
- Monitor you for side effects
- See how you are doing with your chemo plan
Special handling for topical chemo
Chemo you apply to your skin is just as strong as other forms of chemo. Many are also considered hazardous. There are usually special precautions for storing and handling topical chemo. For example:
- You might be told not to let others come into contact with the chemo or your body fluids while taking it and for a time after taking it.
- Wear gloves or use applicators to apply the chemo and avoid touching the area afterward.
- Some types of chemo and the packages they come in need to be disposed of in a certain way.
- Some might need to be returned to the pharmacy to be thrown away safely.
To learn more, see Chemotherapy Safety.
How long does topical chemo stay in the body?
Many people wonder how long the actual chemo stays in their body and how it’s removed. Your kidneys and liver break down most chemo medicines, which then leave your body through urine or stool. How long it takes your body to get rid of the chemo depends on many things, including:
- The type of chemo
- Other medicines you take
- Your age
- How well your kidneys and liver work
Your cancer care team will tell you if you need to take any special precautions because of the chemo you are taking.
What are the side effects of topical chemo?
The side effects of topical chemo vary from medicine to medicine and from person to person. Your cancer care team may not be able to tell you what side effects you’ll have, but they can tell you what to watch for. In general:
- You may experience itching, dryness, swelling, or scarring in the treated area.
- Your skin will likely be reddened and very sensitive for a few weeks.
- Some topical chemo can make the skin more sensitive to sunlight, so treated areas must be protected from the sun to prevent sunburn for a few weeks after treatment.
Tell your cancer care team about side effects right away so they can help you manage any problems. Your doctor may change how much you use or give you other medicines to help you feel better. If you aren’t sure about a side effect and can’t reach your doctor, don’t apply your chemo until you talk to someone on your cancer care team.
Applying chemo topically at home gives you more freedom without having a lot of treatment visits. You may not be seeing your doctor and nurses very often, but be sure to call them with any questions or concerns you have.
Questions to ask before starting topical chemo
Be sure to talk to your care team about what steps to take if you have problems with your medication, including:
- What to do if you miss a dose
- What to do if you lose or misplace the medication
- What to do if you have trouble applying the medication or experience side effects
- How to reach your care team if you have trouble late at night or on the weekend
- Written by
- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
American Society of Clinical Oncology. What is Chemotherapy? Accessed at cancer.net. Content is no longer available.
Cullen JK, Simmons JL, Parson PG, Boyle GM. Topical treatments for skin cancer. Advanced Drug Delivery Reviews. 2020; 153(1 January, 2020):54-64.
Gilson S. Chemotherapy. In Maloney-Newton S, Hickey M, Brant JM, eds. Mosby’s Oncology Nursing Advisor: A Comprehensive Guide to Clinical Practice. 3rd ed. St. Louis: Elsevier; 2024:388-408.
Olsen MM, Fritzsche D, O’Connor SL. Chemotherapy. In Olsen MM, LeFebvre KB, Walker SL, Dunphy EP, eds. Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice. 2nd ed. Pittsburgh, PA: Oncology Nursing Society; 2023:67-100.
Smith LH. Administration Considerations. In Olsen MM, LeFebvre KB, Walker SL, Dunphy EP, eds. Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice. 2nd ed. Pittsburgh, PA: Oncology Nursing Society; 2023:293-340.
Oncology Nursing Society (ONS). Toolkit for Safe Handling of Hazardous Drugs for Nurses in Oncology. Accessed at https://www.ons.org/sites/default/files/2018-06/ONS_Safe_Handling_Toolkit_0.pdf on March 14, 2025
Last Revised: May 15, 2025
American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.
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