Consequences of using escharotic agents as primary treatment for nonmelanoma skin cancer.
BACKGROUND
The use of escharotic or caustic pastes to treat skin cancer is based on the centuries-old observation that selected minerals and plant extracts may be used to destroy certain skin lesions. Zinc chloride and Sanguinaria canadensis (bloodroot) are 2 agents that are used as part of the Mohs chemosurgery fixed-tissue technique. The use of escharotics without surgery has been discredited by allopathic medicine but persists and is promoted among alternative practitioners. Patients may now purchase "herbal supplements" for the primary self-treatment of skin cancer, and physicians will see patients who elect this therapy for their skin cancers.


METHODS
We reviewed the history of escharotic use for skin disease and performed an Internet search for the availability and current use of escharotics. Our search located numerous agents for purchase via the Internet that are advertised as highly successful treatments for skin cancer. We report 4 cases from our practice in which escharotic agents were used by patients to treat basal cell carcinomas in lieu of the recommended conventional treatment. One patient had a complete clinical response, but had a residual tumor on follow-up biopsy. A second patient successfully eradicated all tumors, but severe scarring ensued. A third patient disagreed with us regarding his care and was lost to follow-up. One patient presented with a nasal basal cell carcinoma that "healed" for several years following treatment elsewhere with an escharotic agent but recurred deeply and required an extensive resection. The lesion has since metastasized.


CONCLUSIONS
Escharotic agents are available as herbal supplements and are being used by patients for the treatment of skin cancer. The efficacy of these agents is unproven and their content is unregulated. Serious consequences may result from their use. Conventional medicine has an excellent track record in treating skin cancer. Physicians should recommend against the use of escharotic agents for skin cancer, and the Food and Drug Administration should be given the authority to regulate their production and distribution.
McDaniel
Shana
S
Division of Dermatology, University of Vermont College of Medicine, Fletcher-Allen Health Care, Burlington, VT 05401, USA.
Goldman
Glenn D
GD
D000287:Administration, Topical; D000470:Alkaloids / Q000627:therapeutic use*; D001707:Biopsy, Needle; D002280:Basal Cell Carcinoma / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005153:Facial Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery / Q000379:methods; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D016896:Treatment Outcome
D000470:Alkaloids; C059598:Curaderm