Black salve and escharotics

Version followed: historical and harm account of corrosive "black salve" and related escharotic pastes (bloodroot/sanguinarine with zinc chloride, sold as Cansema, Indian Herb, drawing salve, red salve and other names), as described by the US FDA, Australian regulators, the Australian Journal of General Practice review (Croaker, Lim & Rosendahl 2018) and dermatology case literature. This is not a method a psychotherapist practises, recommends or supervises; nothing here is a description of how to use it, and it is not a treatment for cancer or any other disease.

1. What it was

What it is. "Black salve" is a loose name for topical pastes, creams and ointments whose shared active agents are corrosive (escharotic): mainly zinc chloride and bloodroot (Sanguinaria canadensis), whose red rhizome sap is rich in the alkaloid sanguinarine. An escharotic kills the tissue it touches, which hardens into a dark crust (eschar) that later separates. Zinc chloride is usually the main ingredient by weight, so the "natural" label is inaccurate; some products add other plant extracts or synthetic compounds, and formulations are not standardised, giving "unpredictable clinical effects". [source: Croaker, Lim & Rosendahl 2018, AJGP; FDA warning letter to McDaniel Water LLC, 2021]

Who developed and used it, where and when (as published sources describe). [source: Croaker et al. 2018 unless stated]

Jesse Fell (1850s, United States, later London): a surgeon who combined bloodroot with zinc chloride ("Fell's Paste") as a cancer paste; he was ridiculed by parts of the medical establishment. Fell's 1857 publication is cited in that review [uncertain: not verified].
Harry Hoxsey (1920s onward, United States): sold an escharotic red paste (antimony trisulfide, zinc chloride, bloodroot) through a chain of clinics (the review gives 17); the American Medical Association and FDA opposed him.
Frederic Mohs (1930s, United States): used a zinc chloride fixative paste containing stibnite and bloodroot as the first stage of his chemosurgery, in which fixed tissue was cut away layer by layer and examined under the microscope. The review's authors attribute his high cure rates to the microscopic margin control, not the paste, because the later fresh-tissue (frozen-section) Mohs technique matched them without escharotics; Mohs patented the paste to prevent its standalone use. Fresh frozen tissue later replaced zinc chloride fixation. [source: Croaker et al. 2018; Anderson & Dasher 2022, Cutis]
Almeida Goncalves (1975 onward, Portugal): adapted Mohs' paste (adding galangal) and used it without microscopic control; the review reads the reported initial failure rates as showing the risk of leaving residual cancer when no histology checks the margin.
A US seller (1990s, Alpha Omega Labs): marketed black salve as Cansema, adding further plant materials; according to the review he was convicted of mail fraud and unapproved-drug offences and later sold online from Ecuador. [source: Croaker et al. 2018]
Current commercial products (2010s–2020s): sold online and by mail order under many names, including Skinprov, drawing salve, red salve, Cansema, Bloodroot, Indian Herb, Hawk Dok Natural Salve and Black Drawing Ointment. [source: FDA consumer warning as reproduced by ISMP Consumer Med Safety, 2021] Newer products are often not called "black salve" at all, but "skin tag remover" or "mole corrector" creams. [source: Anderson & Dasher 2022] In 2019 a product called Indian Herb was voluntarily recalled worldwide and FDA issued a safety alert; in 2021 FDA warned McDaniel Water LLC that its "Black Indian Salve" (also sold as Indian Herb) was an unapproved new drug. [source: FDA warning letter 2021]

Stated rationale and how it was sold.

Sellers claim the paste selectively attacks abnormal tissue and "draws out" the growth from beneath the skin, so that the growth detaches and is expelled without surgery. The 2021 FDA warning letter quotes a package insert describing exactly this for "abnormal growths, both external and internal". [source: FDA warning letter 2021; MDedge/Cutis "Fake melanoma and nonmelanoma skin cancer cures"]
It is promoted as natural, safe, easy and cheap; as a "100-year-old folk remedy"; as a cure for skin cancer, moles, warts, skin tags and boils; and, in some sellers' materials, as something also taken internally. [source: FDA warning letter 2021; ISMP 2021; Croaker et al. 2018]
Social media posts frame it as suppressed knowledge (for example, that "the mainstream medical establishment does not want people to know about black salve"). [source: AAP FactCheck, c. 2024]
Laboratory work sometimes cited for selectivity found sanguinarine more toxic to cancer cells than to normal skin cells only within a very narrow concentration window, which plant-to-plant variation makes unreachable in practice; later studies found normal skin cells often more sensitive. [source: Croaker et al. 2018]

Regulatory status (one line each). US: FDA lists black salve among fake cancer cures and treats such products as unapproved new drugs; they are not FDA-regulated or quality-controlled products. [source: FDA warning letter 2021; HealthDay 2016; MDedge] Australia: supply is prohibited and the TGA has warned against use since at least 2012. [source: Croaker et al. 2018; AAP FactCheck] New Zealand: Medsafe states there is no scientific evidence it treats disease. [source: AAP FactCheck, secondary] Evidence: no controlled clinical trial in about 160 years of use; evidence of benefit is limited to case reports. [source: Croaker et al. 2018]

2. What was actually done

The description below is qualitative, drawn from regulator, court-style and clinical reports. It deliberately omits product strengths, amounts, application times and any home-preparation detail.

1. Finding it and "selection" of lesions. Most users hear of black salve from a family member or friend, or from websites and testimonials; in a US interview study only about 30% had seen a dermatologist before trying it and 74% did not know of risks such as infection, scarring and disfigurement. [source: HealthDay 2016 on Cipriano et al., JAAD 2016] Users typically self-select the lesion themselves, without biopsy or examination: a spot they fear is skin cancer, a mole, a skin tag or a wart. Some buy ready-made products online, sometimes labelled for other purposes to evade bans (in Australia, as termite repellent); some make it at home from ingredients bought online. [source: Croaker et al. 2018; AAP FactCheck] One dermatology case describes a man who had used an online "all-natural" cream on a lesion that proved to be melanoma in situ and on many presumed moles, leaving more than 20 small scars on his trunk. [source: Anderson & Dasher 2022]

2. How "consent" was obtained. There is usually no clinician and no consent process. Persuasion comes from marketing and testimonials: "natural", "no surgery", removal "without irritation or scarring", eschar photographs presented as proof of cure, and distrust narratives about mainstream medicine and its treatments. [source: Anderson & Dasher 2022; Croaker et al. 2018; AAP FactCheck] Users have said they chose it to avoid surgery (fear of failure, complications, pain and cost), for convenience, and because clinicians seemed unreceptive and they feared being judged. [source: Croaker et al. 2018 citing Clark et al. 2016; HealthDay 2016]

3. Setting and "staff". Mostly self-administered at home, sometimes by a relative. In some cases an unregistered "healer" applied it: in Victoria, Australia, the Health Complaints Commissioner found that Dennis Wayne Jensen, a self-described healer and hypnotherapist, used black salve on a patient with ovarian cancer over a prolonged period, a painful and ineffective process that burned and destroyed large areas of skin and underlying tissue, and encouraged the patient to stop evidence-based treatment; the patient was treated with it until they died. [source: Health Complaints Commissioner Victoria] Historically, Hoxsey-style clinics applied escharotic pastes in a clinic setting. [source: Croaker et al. 2018]

4. The application as experienced. The paste is put on the lesion (often on and around it) and covered. Users report intense burning pain. The skin and underlying tissue die and form a black, hard crust (eschar), which eventually sloughs off, leaving an open ulcer or crater that heals slowly and scars. [source: Croaker et al. 2018; ISMP 2021; FDA warning letter 2021; AAP FactCheck]

5. How "progress" was judged. The eschar itself is read as proof: that the lesion was cancer (because it "reacted") and that the cancer has been "drawn out" whole. Sellers' materials describe the growth detaching and being expelled. Regulators state the reaction occurs whether or not cancer is present, so it cannot diagnose anything. [source: Croaker et al. 2018; FDA warning letter 2021; AAP FactCheck citing TGA; HealthDay 2016]

6. How non-response or recurrence was handled. Case reports describe continued use while the cancer kept growing, for example a scalp squamous cell carcinoma that grew despite nine months of salve treatment, and a nasal basal cell carcinoma that later caused death from metastasis. [source: Croaker et al. 2018] When the surface heals over, the visible problem seems gone while cancer persists beneath the scar, so the person often does not return for care. [source: HealthDay 2016; Anderson & Dasher 2022] [uncertain: how sellers advise users to respond to recurrence was not verified in primary seller materials]

Named variants. Fell's Paste; Hoxsey's red paste; Mohs zinc chloride fixative paste (used only inside a surgical, microscope-controlled procedure, now superseded); Goncalves' paste; Cansema; Indian Herb / Black Indian Salve (also promoted for internal use); "red salve"; "drawing salve" and "black drawing ointment"; mole and skin-tag remover creams such as Skinprov and HaloDerm products. [source: Croaker et al. 2018; ISMP 2021; FDA warning letter 2021; Anderson & Dasher 2022]

3. How it caused harm

Mechanism. The ingredients are corrosive and do not discriminate between cancerous and healthy tissue; a dermatologist quoted by HealthDay said it "indiscriminately damages anything it touches", and an Australian author compared it to hydrochloric acid. [source: HealthDay 2016; AAP FactCheck] Because depth of destruction is uncontrolled and there is no microscopic check, it can destroy healthy structures while leaving cancer behind. [source: Croaker et al. 2018]

Documented physical harms. [source: Croaker et al. 2018 Box 1 and case series; ISMP 2021; Anderson & Dasher 2022]

Intense burning pain; ulceration with delayed healing; secondary infection.
Scarring, including thick (hypertrophic) and keloid scars needing surgical revision, granulomatous plaques, and pigment changes that themselves needed biopsy. In a series of 25 lesions from case reports, about half scarred and only two had fair-to-good cosmetic results.
Deformity: five lesions caused severe nasal deformity, two with complete loss of the side of the nostril (nasal ala); cartilage loss is reported.
Residual and progressive cancer: cancers left beneath scar tissue; two primary melanomas treated with salve both progressed to metastatic disease; metastatic death from a nasal basal cell carcinoma.
Diagnostic interference: scarring can mask a melanoma, obscure its features on dermoscopy and histology, and lead to delayed diagnosis or inaccurate staging.
Possible carcinogenicity: evidence on sanguinarine is conflicting. [uncertain]
A 2023 pathology study of 409 patients reportedly found high rates of cancer persistence. [source: AAP FactCheck, secondary; uncertain: original not verified]

Deaths and regulator counts. FDA reported awareness of 24 serious adverse-event cases (15 in the preceding five years), most involving permanent damage and cancer progression, and one death of a person who used black salve instead of proven cancer treatment. [source: FDA consumer warning as reproduced by ISMP 2021] The Victorian regulator's case involved a patient with an internal cancer who was treated with salve until death after being encouraged to abandon evidence-based treatment. [source: HCC Victoria]

Psychological sequelae. Published sources focus on physical harm; the following is clinical inference. [synthesis] Visible facial scarring or nasal loss can bring body-image distress, social withdrawal and shame; the pain and the sight of tissue dying can be experienced as traumatic; discovering residual or metastatic cancer can bring intense regret, self-blame and anger at sellers or at oneself; relatives who recommended or applied the product may carry guilt; and fear of being judged by clinicians, already a reason users avoid disclosure, can be amplified after a bad outcome, delaying further care.

Who was most at risk. [source: Croaker et al. 2018; HealthDay 2016; Anderson & Dasher 2022, plus synthesis where marked]

People with suspected melanoma or squamous cell carcinoma, and lesions on the nose, ears, lips and other cosmetically or functionally sensitive sites.
People who self-treat without any prior examination or biopsy.
People strongly motivated to avoid surgery because of fear, pain, cost or past bad experiences of medical treatment.
People with heavy sun damage and many lesions, who may treat many spots, including undiagnosed melanoma.
People with internal cancers persuaded that a salve or an internally taken "herb" product can treat them. [source: FDA warning letter 2021; HCC Victoria]
People isolated from or distrustful of healthcare, or embedded in online communities that promote it. [synthesis]

4. Recognising it today

Product names and labels. [source: ISMP 2021 reproducing FDA; FDA warning letter 2021; Anderson & Dasher 2022; AAP FactCheck]

Names: black salve, Cansema, Indian Herb, Black Indian Salve, "X", red salve, drawing salve, Black Drawing Ointment, Hawk Dok Natural Salve, Bloodroot, Skinprov, and "skin tag remover" or "mole corrector" creams. Product names change quickly and products disappear and reappear.
Label ingredients to recognise, whether listed as active or "inactive": sanguinarine, Sanguinaria canadensis, bloodroot, zinc chloride. FDA advises not buying or using products containing them.
Disguised labelling: sold as something other than a skin product (for example as termite repellent) to evade a ban. [source: AAP FactCheck]
Caution [synthesis]: "drawing salve" is also a name used for some unrelated traditional ointments; a therapist should not try to judge a product's contents, but can suggest the client show the label to a pharmacist or doctor.

Phrases and rationales. [source: FDA warning letter 2021; MDedge; AAP FactCheck; Croaker et al. 2018]

"Draws out" the cancer or "infected" tissue; the eschar as proof that the spot was cancer and that it worked.
"Natural", "folk remedy", "ancient remedy", "no surgery", "no scarring", "miraculous cure", "treats all forms of cancer", "what doctors don't want you to know".
Undocumented before-and-after testimonials and photos, claims to treat serious or incurable disease, and no-risk money-back guarantees are general red flags for fraudulent cancer products. [source: MDedge "Fake melanoma and nonmelanoma skin cancer cures"]
Promotion for internal cancers, or a paired product to be taken by mouth. [source: FDA warning letter 2021; HCC Victoria]

What a therapist may notice in a client. [synthesis, informed by the sources cited]

Talk of treating a spot, mole or "lump" at home; mention of a black scab, a crater, or a mark that "came out"; a dressing on the face, nose, ear or scalp without a medical explanation.
Avoidance of a dermatology or oncology appointment, fear of surgery, cost worries, or a story of a past bad treatment experience. [source: Croaker et al. 2018; HealthDay 2016]
Secrecy: reluctance to tell their doctor because they expect to be judged. [source: HealthDay 2016; Croaker et al. 2018]
Clinicians may see many small, superficial, similar scars (often on the trunk) or a central scar within a pigmented lesion. [source: Anderson & Dasher 2022]

Red flags in a colleague's, healer's or service's practice. [source: HCC Victoria; FDA warning letter 2021; synthesis where marked]

Applying, selling or supplying any corrosive paste for growths, or offering to "draw out" a tumour.
Encouraging a client to stop, delay or avoid evidence-based cancer care.
Claims to cure cancer, including internal cancers.
Selling products to one's own clients, or referral arrangements with sellers. [synthesis; see APA Ethics Code 3.06 on conflicts of interest]
Unregistered practitioners: in Victoria, the Health Complaints Commissioner can investigate unregistered providers under a general code of conduct and issue prohibition orders. [source: HCC Victoria]

How legitimate practice differs. [source: Croaker et al. 2018; Anderson & Dasher 2022]

Diagnosis first: suspicious lesions are examined, and usually biopsied, before treatment; the person knows what the lesion is.
Margin control: standard excision and Mohs micrographic surgery remove tissue with the margin checked microscopically; modern Mohs uses fresh frozen tissue, not a fixative paste. The historical use of a zinc chloride paste inside Mohs chemosurgery is not an endorsement of salve use on its own.
Prescribed topical treatments exist for some diagnosed skin cancers, chosen and monitored by a doctor; their existence does not make an unlabelled corrosive paste equivalent. Any question about them goes to the treating doctor or pharmacist.
Follow-up: treated sites are checked, with a low threshold for histology if anything looks wrong.

5. What to do instead and how to help those harmed

Recommended alternatives (medical, by name). Examination by a GP or board-certified dermatologist for any suspicious, changing or "different" spot; biopsy and histology; standard surgical excision with margins; Mohs micrographic surgery where indicated; doctor-prescribed and monitored treatments for diagnosed lesions; regular surveillance of treated sites with a low threshold for re-biopsy; oncology and palliative care for advanced or internal cancers. [source: Croaker et al. 2018; HealthDay 2016; ISMP 2021] For a person who keeps using salve despite advice, the AJGP authors describe harm minimisation by the GP: examining lesions before use, actively advocating alternatives for high-risk lesions (suspected melanoma or squamous cell carcinoma, ear or lip, cosmetically sensitive sites), and regular surveillance with a low threshold for histology. [source: Croaker et al. 2018] The psychotherapist's role is to make that medical conversation possible, never to assess lesions, advise on products or wound care, or recommend any treatment.

The psychotherapist's own work follows. Each item is the therapist's practice, not a medical intervention.

5.1 Asking routinely and without judgement

Purpose / when: Users often hide salve use because they fear being judged; asking makes disclosure possible. Use at intake and whenever a client mentions a skin problem, a cancer diagnosis, a refused procedure or home remedies. [source: HealthDay 2016; Croaker et al. 2018; Salamonsen & Frenkel 2015]
Steps: 1) Ask about all treatments, including "natural", online or home ones, as a normal part of health history. 2) If salve or a similar product is named, ask what it is called, what it is being used for, whether a doctor has seen the area, and whether there is pain, an open wound, spreading redness or fever. 3) Thank them for telling you. 4) Record product name, purpose, whether medical care is involved, and any urgent concerns. [steps 1, 2, 4 adapted from Salamonsen & Frenkel 2015; risk questions are synthesis]
Example language (illustrative): "Lots of people try things at home or online before seeing a doctor. Is there anything you've been using on that spot, or for your health more generally?" / "I'm glad you told me. I'm not here to tell you off; I'd like to understand what you're hoping it will do."
Watch for: Minimising, changing the subject, or defensiveness (pace the conversation); any sign of acute harm (open or worsening wound, spreading redness, fever, severe pain), which calls for same-day medical care. [synthesis] It is working when the client volunteers details and later updates you.

5.2 Exploring meaning, hopes and the client's explanatory model

Purpose / when: Choices are driven by fear of surgery, pain, cost, past bad experiences, a wish for control or naturalness, trust in the person who recommended it, and distrust of medicine. Understanding these guides what will help. [source: Croaker et al. 2018; Shumay et al. 2001; Salamonsen & Frenkel 2015]
Steps: 1) Ask what they believe the salve does and how they will know it has worked. 2) Ask what conventional care they have tried, avoided or fear, and why. 3) Ask who recommended it and what that relationship means. 4) Reflect values (autonomy, safety, avoiding pain, appearance, cost) without debating facts. 5) Note specific fears that a doctor could address (for example, fear of a facial scar from surgery). [source: Salamonsen & Frenkel 2015 steps 1–4 and 6; synthesis for wording]
Example language (illustrative): "What's made this feel like a better option than seeing the skin doctor?" / "It sounds like the thought of surgery on your face is really frightening. Can we stay with that for a moment?"
Watch for: Fear is a frequent driver of declining conventional treatment, and people may overestimate its risks after poor interactions with clinicians; information alone is often not enough. [source: Shumay et al. 2001] Progress shows as the client naming the fear rather than defending the product.

5.3 Autonomy-respecting decision support

Purpose / when: To help the client make an informed, values-based choice without coercion, when they are considering, using or continuing salve, or declining a recommended procedure.
Steps: 1) Ask permission to talk about the decision. 2) Explore their understanding of the diagnosis (if any), prognosis and the options, including no treatment. 3) Encourage them to get the facts from the treating clinician: what the lesion is, what each option involves, and the risks of each. 4) Where the client asks what you know, share regulator facts plainly and briefly (for example, that FDA and the Australian regulator warn it destroys healthy tissue, can leave cancer behind and has caused disfigurement and death), and say that you are not a medical expert. 5) Summarise their decision and reasons, document it, and keep the door open. [source: Salamonsen & Frenkel 2015 steps 7–12; Shumay et al. 2001; ISMP 2021; Croaker et al. 2018 Box 2; synthesis for sequencing]
Example language (illustrative): "It's your decision. My part is to make sure you have what you need to make it. Would it help to write down the questions you'd want the dermatologist to answer?" / "Whatever you decide today, you can change your mind later, and I'll still be here."
Watch for: Pressure from you can push the client away; patients who decline may choose conventional care later with support, information and time, and should not feel excluded from the healthcare system. [source: Shumay et al. 2001] Watch for capacity concerns, coercion by others, or a decision made in panic. It is working when the client attends a medical appointment or can state the trade-offs in their own words.

5.4 Coordinating with the GP, dermatologist, oncology and palliative teams

Purpose / when: With consent, to make sure the medical team knows about salve use and the client's fears, so they can examine, treat and monitor. Use whenever salve is in use or a lesion has been treated with it. [source: APA Ethics Code 3.09; ISMP 2021 advice to tell the doctor about any products used; Croaker et al. 2018]
Steps: 1) Explain why sharing helps (scarring can mask cancer; the doctor needs to know to check properly). 2) Obtain written consent specifying what will be shared. 3) Share the product name, the area treated, and the client's main fears and wishes; do not describe or judge the wound clinically. 4) Offer to help the client prepare for the appointment (questions, a support person). 5) Agree how you and the doctor will keep each other informed. [source: Anderson & Dasher 2022 on masking; APA 3.10, 4.05; synthesis]
Example language (illustrative): "Would you be OK with me letting Dr X know you've been using the salve, so they can look at the area properly? I'd only share what we agree."
Watch for: Refusal of consent (respect it, revisit, see 5.11 for exceptions); the client feeling "reported". It is working when the medical team is involved and the client feels accompanied rather than corrected.

5.5 Working with fear of surgery, procedures and medical settings

Purpose / when: Avoiding surgery is the main stated motive for salve use; treating the fear can open the way to medical care. [source: Croaker et al. 2018 citing Clark et al. 2016]
Steps [synthesis]: 1) Assess the fear: procedural, pain, blood or needle, disfigurement, cost, past medical trauma. 2) Use established approaches for medical and procedural anxiety (psychoeducation, graded exposure to medical settings and information, cognitive work on catastrophic predictions, coping and relaxation skills for appointments); see Domain II for health anxiety and somatic presentations. 3) Help the client ask the doctor practical questions about pain control, scarring and cost. 4) Rehearse the appointment.
Example language (illustrative): "What's the worst part of picturing the operation? ... What would you need to know, or have with you, to make that more bearable?"
Watch for: Exposure-based work requires consent, pacing and the right to stop; do not let anxiety work delay urgent medical review of a lesion that may be cancer. It is working when avoidance falls and appointments are kept.

5.6 Staying alongside a client who continues to use it

Purpose / when: When a client with capacity chooses to keep using salve, to keep the relationship and the route to medical care open.
Steps: 1) Acknowledge their choice without endorsing it. 2) Encourage them to have the lesion examined, and treated sites checked regularly, by a doctor, as the AJGP harm-minimisation approach describes. [source: Croaker et al. 2018] 3) Agree in advance on warning signs that mean urgent medical care: spreading redness, fever, a deepening or non-healing wound, severe pain, bleeding, or the spot returning or changing. [synthesis] 4) Never give advice on application, wound care or products. 5) Revisit the decision at agreed intervals.
Example language (illustrative): "I hear that you want to carry on. Can we agree that if the area gets red, hot, smells, or won't heal, you'll get it seen that day?"
Watch for: Collusion (avoiding the topic to protect rapport), or the reverse, repeated lecturing. It is working when the client keeps you informed and keeps a medical contact.

5.7 Body image, disfigurement and shame

Purpose / when: After scarring or facial deformity (for example nasal loss), or when facing surgical revision. [source for harms: Croaker et al. 2018]
Steps [synthesis]: 1) Assess distress, avoidance (mirrors, photos, social contact), and mood. 2) Use established body-image and appearance-distress approaches (cognitive-behavioural work on appearance-related beliefs and safety behaviours, graded social re-engagement, compassion-focused work on shame). 3) Support decisions about scar revision or reconstruction by helping the client prepare questions for the surgeon. 4) Screen for depression and suicidality and respond using standard risk assessment.
Example language (illustrative): "When you catch sight of your face now, what goes through your mind?" / "What has this changed about how you go out and see people?"
Watch for: Withdrawal, hopelessness, self-blame; cancer recurrence fears expressed as checking the scar. It is working when avoidance shrinks and the client re-engages with valued activities.

5.8 Trauma responses to the treatment experience

Purpose / when: Some clients describe intense pain and watching tissue die and fall away; others were treated by a practitioner they trusted who harmed them. [harm description: Croaker et al. 2018; HCC Victoria]
Steps [synthesis]: 1) Screen for intrusive memories, avoidance, hyperarousal and medical avoidance. 2) Stabilise first: grounding, sleep, and safety in medical settings. 3) Where criteria are met, offer an evidence-based trauma-focused therapy, adapting for ongoing medical procedures. 4) Address betrayal by a trusted healer or relative directly.
Example language (illustrative): "Some people find those weeks come back to them as pictures or feelings in the body. Does anything like that happen for you?"
Watch for: Overwhelm or dissociation in session (slow down, return to grounding); trauma avoidance that stops follow-up dermatology care.

5.9 Grief, regret and guilt

Purpose / when: When salve use was followed by residual cancer, metastasis or death; for the person who chose it, and for relatives who recommended, applied or opposed it.
Steps [synthesis]: 1) Let the client tell the story in their own order. 2) Separate hindsight knowledge from what was known and feared at the time (the marketing was persuasive and designed to look safe and natural). 3) Name the role of sellers and practitioners who made false claims, without removing the client's agency. 4) Work with self-blame using compassion-focused and cognitive approaches; for bereaved relatives, use established grief interventions and watch for prolonged grief. 5) Where the person is now facing advanced cancer, support meaning, legacy and relationships alongside the palliative team.
Example language (illustrative): "You made that choice with what you knew and feared at the time. Looking back now with more information is a different position." / "You can be angry at the people who sold it to you and still be sad about your own part. Both can be true."
Watch for: Rumination, guilt that blocks seeking further treatment, suicidal thinking (assess using standard practice), and anger turned on relatives.

5.10 Family conflict

Purpose / when: Families often split between those who promote salve (most users hear of it from family or friends) and those who want conventional care; conflict can escalate around a seriously ill person. [source: HealthDay 2016; synthesis for interventions]
Steps [synthesis]: 1) With consent, meet relevant family members. 2) Centre the patient's own values and decision. 3) Help family members express fear and love rather than argue facts. 4) Agree shared roles (for example, one person accompanies the patient to appointments). 5) After a death, support relatives working through blame.
Example language (illustrative): "It sounds like everyone here is frightened of losing her, and you're each showing it in different ways."
Watch for: One relative controlling access to care, or coercion in either direction (see 5.11).

5.11 Safeguarding: children and adults at risk

Purpose / when: When a child's skin lesions are being treated with salve, when a child is deprived of medical care, or when an adult at risk is being pressured or treated by others. [synthesis; applying general safeguarding principles]
Steps: 1) Treat the application of a corrosive paste to a child, or withholding medical assessment of a child's suspected cancer, as a safeguarding concern; follow local child-protection procedures and consult your safeguarding lead. 2) Consider the child's own view (assent) appropriate to age, alongside parental consent, and the child's right to medical care. 3) For adults, consider capacity, undue influence and coercive control, including by a "healer". 4) Document concerns and actions. 5) Breaking confidentiality without consent should follow law and your code (for APA members, Standard 4.05 limits disclosure to what is necessary). [source: APA Ethics Code 4.05, 3.04; rest synthesis]
Example language (illustrative): "Because this involves your son's health, I need to talk with you about getting him seen by a doctor, and about what I'm required to do if that doesn't happen."
Watch for: Escalating secrecy, missed medical appointments, visible wounds on a child. Never name children in records shared outside the clinical team beyond what procedures require.

5.12 Financial harm and exploitation

Purpose / when: Clients may have spent money on products, consultations or travel, or been drawn into selling.
Steps [synthesis]: 1) Ask about money spent, any ongoing payments or subscriptions, and any crowdfunding or family fundraising. 2) Explore shame about having been deceived. 3) Signpost to consumer-protection bodies and, where fraud is suspected, the police. 4) Help with budgeting stress via appropriate services.
Example language (illustrative): "These products are marketed by people who know how to make them sound trustworthy. Has it cost you more than you expected?"
Watch for: Continued spending on new "cures"; pressure from sellers or online groups to buy more.

5.13 Online communities and testimonials

Purpose / when: Salve promotion relies on social media, testimonials and "suppressed cure" narratives. [source: AAP FactCheck; MDedge; Croaker et al. 2018]
Steps [synthesis]: 1) Ask where the client gets information and who they talk to. 2) Explore what belonging to that community gives them (hope, being heard). 3) Help them notice persuasion features (before-and-after photos, money-back guarantees, "they don't want you to know") without ridiculing the people involved. 4) Help them find other sources of support, such as cancer support organisations.
Example language (illustrative): "What do the people in that group give you that you haven't been getting from the clinic?"
Watch for: Group pressure to avoid doctors; loss of contact with family. Signs of high-control group dynamics need careful, unhurried work.

5.14 Reporting

Purpose / when: When a client has been harmed, a product is being sold, or a practitioner is applying salve or discouraging cancer treatment. Encourage and support the client to report; report yourself where your role and law require. [synthesis unless cited]
Routes:
- United States: FDA (adverse events and unapproved products; FDA has issued warning letters to sellers). [source: FDA warning letter 2021] [uncertain: specific FDA reporting portal details not verified]
- Australia: the TGA (supply is prohibited); for unregistered practitioners in Victoria, the Health Complaints Commissioner, which has issued prohibition orders and takes complaints by phone or online. [source: AAP FactCheck; HCC Victoria] Other states have equivalent health complaints bodies. [uncertain: not verified]
- Elsewhere: the national medicines regulator, advertising or consumer-protection regulators, and the relevant professional board if a registered professional is involved. [synthesis]
- Police: where a death, serious injury or fraud is involved. [synthesis]
Example language (illustrative): "What happened to you could happen to others. If you'd like to report it, I can help you work out where and what to say."
Watch for: Clients may fear blame or legal trouble for having used the product; reassure them the reports concern sellers and practitioners.

Ethical and professional duties for the therapist

Stay within competence: do not assess lesions, comment on wound appearance as a clinician, or advise on any product, medicine or treatment; refer to medical professionals. [source: APA Ethics Code 2.01, 2.04]
Avoid harm and conflicts of interest: never sell, supply, recommend or profit from such products or related courses. [source: APA Ethics Code 3.04, 3.06]
Respect self-determination while acting on safeguarding duties. [source: APA Ethics Code Principle E, aspirational; 4.05]
Cooperate with other professionals and keep records of disclosures, decisions, consent to share and safeguarding actions. [source: APA Ethics Code 3.09, 3.10, 6.01]

Handling problems [synthesis unless cited]

Client refuses any medical review: respect capacity, keep the door open, revisit regularly, agree urgent-care warning signs, and consider whether safeguarding applies. [source for keeping the door open: Shumay et al. 2001]
Client conceals use and you discover it later: name it gently, avoid confrontation, return to 5.1 and 5.2.
Client shows you a wound in session: do not examine or advise; encourage same-day medical review if there are signs of infection or deterioration.
Therapist's own strong reactions (horror, frustration): use supervision; reactions can become judgement that drives secrecy. [link to fear of judgement: HealthDay 2016]
Client in a palliative phase after choosing salve: prioritise comfort, meaning and relationships; coordinate with the palliative team; do not revisit the decision unless the client wants to.
Rupture after you raised safety concerns: acknowledge the impact, restate respect for their autonomy, clarify your limits, and repair before returning to the topic.

Sources

Croaker A, Lim A, Rosendahl C (2018). Black salve in a nutshell. Australian Journal of General Practice 47(12). doi:10.31128/AJGP-07-18-4657. Black salve in a nutshell (RACGP)
US FDA, Center for Drug Evaluation and Research (7 September 2021). Warning letter 616186 to McDaniel Water, LLC. FDA warning letter: McDaniel Water LLC
Institute for Safe Medication Practices, Consumer Med Safety (1 February 2021). FDA alert reproducing the FDA consumer update "Do not use black salve: it is dangerous and called by many names". Black salve is dangerous and has many names [uncertain: FDA's own consumer-update page not verified directly]
Anderson M, Dasher D (2022). At-home treatment of pigmented lesions with a zinc chloride preparation. Cutis 109(2):E25–E26. doi:10.12788/cutis.0482. Cutis case letter (PDF)
MDedge / Cutis. Fake melanoma and nonmelanoma skin cancer cures (summarising Hou and Brewer 2015, Cutis). Fake melanoma and nonmelanoma skin cancer cures
HealthDay (23 May 2016). Home remedy for skin cancer may cause damage, mask new growth (reporting Cipriano and colleagues, J Am Acad Dermatol 2016). HealthDay report
Community perceptions about the use of black salve (2016). J Am Acad Dermatol 74(5):1021–1023. doi:10.1016/j.jaad.2015.10.016. PubMed record [uncertain: full author list not verified]
Health Complaints Commissioner, Victoria. Alternative therapist banned from providing general health services. HCC Victoria news
AAP FactCheck (c. 2024). Black salve "cancer cure" makes the skin crawl. AAP FactCheck
Salamonsen A, Frenkel M (2015). How to communicate effectively about complementary, integrative and alternative medicine. NAFKAM / CAM-Cancer Consortium. NAFKAM
Shumay DM, Maskarinec G, Kakai H, Gotay CC (2001). Why some cancer patients choose complementary and alternative medicine instead of conventional treatment. Journal of Family Practice 50(12):1067. MDedge
American Psychological Association. Ethical Principles of Psychologists and Code of Conduct (effective 2003; amendments effective 2010 and 2017). APA Ethics Code
As cited in Croaker et al. 2018: Fell J (1857) on his cancer paste; Clark et al. (2016) survey of black salve users; Goncalves (1986); Ahmad et al. (2000). [uncertain: not verified]
TGA consumer warnings on black and red salves (2012 onward) are cited as reported by Croaker et al. 2018 and AAP FactCheck. [uncertain: TGA page not verified directly]

← Previous · XII-154Essiac Next · XII-156 →Antineoplastons (Burzynski)