Abstract: We report the case of a 47-year-old woman who presented to the emergency department with a 9.7cm × 8.3cm melanoma on her foot, which impeded her ability to walk. The patient had been treating the fungating mass with black salve after seeking treatment from a homeopathic physician when first noticing a mole increasing in size several years previously. Additionally, we examine published reports of giant melanoma in the literature and investigate the possible maleficence of black salve treatment.
We present the case of a 47-year-old Caucasian woman who visited the emergency department with a growth on the plantar surface of her left heel that she stated had been increasing in size for at least one year. She denied any personal or family history of skin cancer. She was accompanied by her mother and brother to the emergency department. They stated that she lived alone and had refused to see a doctor since she was a child. Her family reported that they had brought her to the hospital after noticing a foul odor coming from her foot and discovering the growth that had been wrapped and hidden. Upon further questioning, the patient stated that she had noticed a “coin-sized” mole on her foot, which had been present since birth, had begun growing in size several years ago. She attributed this to normal aging. When she first noted the lesion increasing in size, she sought treatment from a homeopathic physician who recommended using a black salve ointment. She was told that the black salve would cause the lesion to ulcerate, and she believed the treatment was working when she noticed the lesion ulcerating along with a foul smell. Of note, she also stated that her past medical history was positive for a self-diagnosed “groin hernia,” which she described as a softball-sized inguinal mass. She reported that the mass had developed one month prior to the presentation but had self-resolved after several days. She denied any past medical or surgical history and denied excess sunlight exposure or tanning. Physical examination revealed a fungating mass measuring approximately 10cm×8cm on the plantar surface of the left foot. It was not painful to palpation and did not have gross drainage. However, a noticeably foul odor was present upon removing the bandaging.
The patient met severe sepsis criteria on presentation and was empirically started on intranveous vancomycin and piperacillin-tazobactam for the treatment of the soft tissue mass superinfection. However, she later refused antibiotic treatment, as she believed that the intravenous medicines were worsening her illness. She was transitioned to oral trimethoprim/sulfamethoxazole on the third hospital day and completed 10 days of antibiotic therapy. She was also started on anticoagulation with enoxaparin due to her bilateral pulmonary emboli, but subsequently refused treatment as well as further laboratory work.
Discussion
This case is unique in that our patient did not seek care from a traditional physician for several years after first noticing the changing lesion on her foot. However, this aligns with her history of refusing to see a doctor since childhood, instead turning to homeopathy for treatment. Use of the internet makes it easier for patients to search for alternative medicine and “natural” treatments for their skin lesions. Escharotic agents like black salve have a long history of being used to treat skin lesions and cancerous growths and have been used by Native Americans for centuries.13 A Google search produced a handful of websites selling variations of black salve products containing Sanguinaria under different names, including Cansema® (Alpha Omega Labs, Guayaquil, Ecuador) and HerbVeil8® (Altered States). They label black salve as a safe and natural cure for basal cell carcinoma, squamous cell carcinoma, and melanoma despite no randomized, clinical trials demonstrating efficacy or FDA approval.11–13,15Leecy et al15 published a report of 16 case studies and a review of the literature in which black salve was applied to cutaneous lesions, finding that the majority of outcomes included dermal scarring, necrosis, ulceration, a need for reconstructive surgery, recurrence of cancer, and death. While it is true that treatment with an escharotic-like black salve can cause an inflammatory tissue response with scarring and fibrosis, there is no histological evidence to support the claim that black salve leads to selective destruction of neoplastic cells.15 There are only two case reports in the literature of attempting to treat melanoma with black salve. Both patients in the case reports progressed to metastatic melanoma.12,16Lack of regulation of information published on the internet makes false, misleading information easily accessible to the public. This allows the social media user next door and alternative medicine websites professing the efficacy of black salve to promote these “natural” remedies without mention of the possible side effects, toxicity, and negative outcomes due to delayed medical care. It is possible that the homeopathic physician who treated our patient did not provide her with the likely diagnosis of melanoma or enough information to make an educated decision when she was instructed to treat the lesion with black salve. It is also feasible that the patient ignored advice to seek medical care and chose to solely treat with black salve. This case demonstrates the importance of educating the public and all health care providers about the “ABCDEs” of melanoma and the importance of early detection along with the potential dangers of treatment with natural remedies such as black salve.
Conclusion ( Mine) She is dead. Black Salve , and Homeopathy killed her . The Internet provided the links to the enablers that killed her
