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May 2018

The Dangers of Black Salve: An Unregulated, Commercially Available Caustic Agent

Author Affiliations
  • 1The Robert Larner, MD College of Medicine at the University of Vermont, Burlington
  • 2Division of Dermatology, University of Vermont Medical Center, Burlington
JAMA Dermatol. 2018;154(5):618-619. doi:10.1001/jamadermatol.2018.0146

A man in his 70s with a history of basal cell carcinoma (BCC) presented for evaluation of multiple back lesions. The patient was seen in clinic 2 months earlier for biopsy-proven BCC. Three weeks before excisional surgery, the patient self-treated his upper back biopsy site and two neighboring, likely benign, locations with topical Cansema (Alpha Omega Labs) black salve. Within days, the patient developed severe pain and discharge at the sites of application, which prompted urgent evaluation. Eschars with peripheral erythema and necrotic ulcerations were subsequently identified (Figure). Further use of black salve was strongly discouraged. The ulcerated biopsy site was excised shortly thereafter, and the final pathology report demonstrated no residual carcinoma, although there was concern that the original biopsy site might have been obscured by the induced inflammation.