3 December 2013
Black salve and related products are promoted as an alternative to conventional medicine for treating skin problems including skin cancer. These products work by ‘burning away’ (destroying) the skin (both healthy and potentially diseased) to form a thick black scab which eventually falls off. There is no scientific evidence that black salve and similar products are effective at treating disease/skin conditions.
A case of a severe necrotic lesion caused by black salve has been reported to the Centre for Adverse Reactions Monitoring (CARM). Consumers should be aware of the risks if they are considering using these unregulated products.
These products are not regulated medicines in New Zealand. There is no monitoring of the quality, content or safety of these products.
Black salves generally contain zinc chloride (a pharmacy medicine when used on the skin) and/or the benzylisoquinoline alkaloid sanguinarine obtained from the bloodroot plant (Sanguinaria Canadensis).
These products may also be known as: red salves, yellow salves, Cansema, Can-X, Curaderm, Hoxsey’s dark red paste, bloodroot paste and Mexican black salve.
Eastman et al. 2013 have provided a comparison of black salve and conventional surgery.
|Factor||Black Salve||Conventional Standard of Care|
|Success (no skin cancer recurrence)||Unknown||Nonmelanoma skin cancer
M: 67-99%, SE: 80-100%, EDC 92-98%
M: 67-99.5%, SE: 80-100%
|Efficiency||Days to weeks||Complete in 1 day|
|Precise anatomic control||Difficult||Easy|
|Conservation of normal tissue||Fair to poor||Good to fair|
|Repair||Delayed secondary intension||M and SE immediate, primary closure
EDC delayed secondary intention
|Cosmetic appearance||Good to poor||Good to fair|
M = Mohs micrographic surgery
SE = Surgical excision
EDC = Electrodessication and curettage
Summary of published case reports of effects in consumers using black salves.
|Reference||Cancer||Biopsy Proven||Outcome||Residual Cancer?|
|Eastman et al. 2011||Unknown neoplasm on nose||No||Complete loss of left nasal ala||Unknown|
|Osswald et al. 2005||BCC on nose||Yes||Defect healed by secondary intention||Unknown|
|Brown et al. 2001||BCC on left cheek||Yes||Underwent three scar revisions||No|
|SCC on right lower leg||Yes||Defect healed by secondary intention without complication||No|
|McDaniel et al. 2002||BCC on right temple||Yes||Defect healed by secondary intention subsequent Mohs surgery to excise residual tumour||Yes|
|BCC on right neck||Yes||Defect healed with triangular keloid scar underwent revision surgery||No|
|BCCs on nose lip and cheek||Yes||Underwent Mohs surgery, partial maxillectomy; BCC metastasised to lymph nodes and bony sites||Yes|
|Saltzberg et al. 2009||BCC on left nasal ala||Yes||Complete loss of left nasal ala||Unknown|
|Jellnek et al. 2005||BCC on nose and scalp||Yes||Defect healed with scar over which the BCCs recurred, patient underwent Mohs surgery||Yes|
|Laub 2008||BCC on nose, lip, cheek||Yes||Underwent Mohs surgery, partial maxillectomy, radical neck lymphadenopathy, radiation and chemotherapy. Developed multiple bony metastases and died||Yes|
|Cienki et al. 2010||Malignant melanoma on chest||Yes||Referred to surgical oncology team||Yes|
|Unknown subcutaneous abdominal nodules||No||Developed enterocutaneous fistulae, given bowel rest and discharged without complications||Unknown|
|Affleck et al. 2007||BCC on nose||Yes||Fair cosmetic outcomes with depressed irregular scar on nasal tip||Unknown|
Medsafe investigates products that make therapeutic claims or contain scheduled ingredients that appear to be marketed in breach of the Medicines Act 1981.
|Phone||(03) 479-7247 to speak to a Medical Advisor at CARM
From your iPhone using the ADR online app
Submit an online report
Prescribers can submit using the online reporting tool available in patient management software
|Yellow Card||A completed Yellow card can be submitted to CARM via email, fax or mail (address is on the card)|
Medsafe cannot give advice about an individual’s medical condition. If you have any concerns about a medicine you are taking Medsafe encourages you to talk to your healthcare professional.
Eastman KL, McFarland LV, Raugi GJ. 2013. A review of topical
corrosive Black Salve. Journal of Alternative and Complementary
Medicine 18: DOI: 10.1089/acm.2012.0377.
Eastman K, McFarland L, Raugi G. 2011. Buyer beware: a black salve caution. Journal of the American Academy of Dermatology 65: e154.
Osswald SS, Elston DM, Farley MF, et al. 2005. Self-treatment of a basal cell carcinoma with "black and yellow salve". Journal of the American Academy of Dermatology 53: 509-511.
Brown CW, Goldstein GD, Birkby CS. 2001. Auto-mohs.com. Dermatologic Surgery 27: 975-978.
McDaniel S, Goldman GD. 2002. Consequences of using escharotic agents as primary treatment for nonmelanoma skin cancer. Archives of Dermatology 138: 1593-1596.
Saltzberg F, Barron G, Fenske N. 2009. Deforming self-treatment with herbal "black salve". Dermatological Surgery 35: 1152-1154.
Jellnek N, Maloney ME. 2005. Escharotic and other botanical agents for the treatment of skin cancer: a review. Journal of the American Academy of Dermatology 53: 487-495.
Laub DR. 2008. Death from metastatic basal cell carcinoma: a herbal remedy or just unlucky. Journal of Plastic Reconstructive and Aesthetic Surgery 61: 846-848.
Cienki JJ, Zaret L. 2010. An internet misadventure: bloodroot salve toxicity. Journal of Alternative and Complemenary Medicine 16: 1125-1127.
Affleck AG, Varma S. 2007. A case of do-it-yourself Mohs' surgery using bloodroot obtained from the internet. British Journal of Dermatology 157: 1078-1079.