Skin Cancer Scenario

A 32-year-old woman, Cindy, presented to her doctor with a melanoma on her right arm in March. Cindy is a single mother, with three children, and works a minimum wage job. Her doctor told Cindy that she would need a complete excision of the lesion. The costs associated with the procedure and time of recovery demanded worried Cindy. She was worried that she might not be able to afford to pay for the procedure, nor could she afford not being available at home for her children.

Cindy took the referral from her doctor and was supposed to schedule her appointment for the procedure. In April, her doctor called to follow up regarding her treatment, and Cindy let her know that she would not be moving forward with treatment. Her doctor urged her to come and see her[i] to talk about her decision. In despair, Cindy looked for other options. As she was telling her situation to her cousin, Danielle, Danielle excitedly told her about black salve, a proclaimed anti-cancer treatment that Cindy could do herself, at an affordable cost. Black salve became a very attractive option for Cindy since she would not have to pay for a procedure or worry about childcare. However, she didn’t know much about black salve, and could not seem to find a consensus on the information she was reading.

What would you do? Would you dismiss your doctor’s advice? Would you use black salve as your cancer treatment without fully understanding how it works?


What is Black Salve?

Black salve[1] is an escharotic agent, containing bloodroot (Sanguinaria canadensis), or zinc chloride to act as a corrosive topical treatment.

Attraction to black salve as an alternative treatment for skin cancer

Black salve is being used as an alternative treatment to cure skin cancer. Many people are attracted to black salve for various reasons, one being, the cost. Black salve can be purchased online for as low as $8.00, while average skin cancer treatments can be much more expensive, depending on the type of insurance.[2] Another reason people are finding black salve attractive is its potential anti-cancer ability from self-reported success stories. Lastly, as skin cancer treatments could be intense, black salve seems to give an “easy way out”.


Risks of Using Black Salve as a Cancer Treatment

Because of the lack of evidence-based research and lack of randomized clinical trials on black salve, the FDA, U.S. Food and Drug Administration, classifies black salve as an illegally sold cancer treatment.[3] Therefore, any information we have regarding black salve is based off case studies of people’s experiences.

Serious risks of black salve include

  1. The chemical makeup of black salve does not discriminate between the cancerous skin and healthy skin.[1] Therefore, it can severely damage healthy skin
  1. Burning of skin and possibly leaving large open wounds[1]
  1. Black salve as a topical agent does not guarantee that all cancer cells have been killed, therefore cancer can continue to spread unnoticed, and lead to an even more severe case of metastatic cancer that can result in death.


Ethical Roles in the Patient-Physician Relationship

Physician’s role to their patient

As we reflect on Cindy’s case, we see how the doctor urged her patient to go back to her and discuss her decision further before moving forward with any treatment. Although the doctor must respect her patient’s autonomy, she must also look towards what is best for her patient. To do this, a doctor will try to disclose all information to her patients about the treatment options, including, risks, benefits, and alternative treatments. The doctor may not know much about the black salve but she could have looked on the internet with Cindy or taken time to do more research and then have Cindy return for a further discussion

Patient’s role in their own healthcare

Cindy has a responsibility in her healthcare in this scenario. If Cindy had openly communicated with her doctor, she would be able to better understand if there is any science, as well as the side effects of using black salve. In Cindy’s case, she should explore the values, concerns, and needs regarding her skin cancer treatment in general, so that her doctor can address these concerns too.


How to Approach Similar Scenarios with Your Doctor

If you find yourself in a position similar to Cindy’s, in which you are considering alternative treatments because of price or worry, it is important to have open communication with your doctor. Your doctor may be aware of alternative treatments or be able to look into the medical literature to help you understand the risks. and can advise and inform you of the benefits and risks of a treatment you are considering. It is safer to have a doctor’s support and guidance in your decisions. In some cases, your doctor may push you to take the expensive option because it is the only option that really works. This can mean a lot if the consequence of using incorrect treatment can leave you injured, sick, or even result in death in the case of an undertreated melanoma that spreads to the rest of the body.

Key Takeaways

  • Openly communicate with your doctor even if you are worried about cost, price, or an alternative treatment
  • The consequence of undertreating melanoma is death

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