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Use of unlicensed black salve for cutaneous malignancy

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To the Editor: The most frequently diagnosed cancers in Australia are non-melanoma skin cancers.1 Recommended treatments include surgical excision, radiotherapy and topical chemotherapy for in-situ lesions.2 There has been an increase in sales of lotions and salves that claim to eradicate skin lesions and promote removal of skin cancers. In 2012, the Therapeutic Goods Administration issued a public warning strongly advising patients against the use of red and black salves.3 We report a recent case illustrating the complications resulting from use of these unlicensed products.

A 55-year-old man presented to the emergency department at Princess Alexandra Hospital, Brisbane, with a tissue defect on his right temple (Box). The patient had applied black salve to a lesion, which he believed to be cancerous, over the previous 4 months.

Before the Therapeutic Goods Administration warning, topical preparations such as black and red salves were being sold online to Australians as an alternative treatment for skin cancer. These products contain sanguinarine, a benzylisoquinolone alkaloid derived from bloodroot (Sanguinaria canadensis).3