News, Views, and Reviews: Safety & Efficacy of Agents Used for Home Mole Removal and Skin Cancer Treatment in the Internet Age, and Analysis of Cases

September 2013 | Volume 12 | Issue 9 | Feature | 1058 | Copyright © 2013

Brandon L. Adler and Adam J. Friedman MD

Abstract

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Safety & Efficacy of Agents Used for Home Mole Removal and Skin Cancer Treatment in the Internet Age, and Analysis of Cases

Logging On

The Internet is a rapidly growing first-line resource for health- and illness-related information for a significant number of patients. Between 2000-2001, 40 to 55% of adults with Internet access reported searching for topics related to their health.1,2 By 2012, that number jumped to 72%.3

Alternative medicine also has a solid niche online. As many as 41% of patients turning to the Internet for health information do so to learn about complementary and alternative medicine (CAM) solutions.4 In 2002, 49.4% of patients reporting skin problems in the past year had used some form of CAM, with 6.0% using it specifically for skin-related issues.5 This demographic may contribute to large forums like CureZone, with “2,043,953 messages, 167,027 registered members, over 18 million readers,”6 and Topicalinfo’s skin cancer topical treatments forum, with over 5,000 posts.7 Dermatology is aware of the role social media will play in its future,8 but has devoted little attention to the presence of online forums and their influence on patient healthcare decisions.

Usual Suspects & New Players

Mole removal and self-treatment of skin cancer are topics that frequently arise on CAM forums. Solutions recommended to inquiring users include escharotic agents – including bloodroot (Sanguinaria canadensis), zinc chloride, and Cheilidonium majus – in addition to solasodine glycosides. Each of these ingredients will be briefly reviewed below.

Dr. Frederick Mohs originally used bloodroot (Sanguinaria canadensis) as the binder (“agglutinant”) for zinc chloride in his topical fixative paste, first used in the 1930s in the method he termed chemosurgery.9 Bloodroot – containing the bioactive alkaloid sanguinarine – and zinc chloride are both powerful escharotics,caustic agents that produce inflammation, necrosis, and eschar formation. Used indiscriminately they can produce substantial pain and scarring.

In 1948, Mohs ceased using escharotics as a solitary treatment in the absence of surgery, owing to their potential for widespread skin damage, destruction of unaffected tissue, and uncertainty of complete cure.10 An influential 1978 paper introduced a frozen sectioning technique that eliminated the escharotic fixative and improved the complete removal of skin cancer with less associated pain, sacrificing less normal tissue and shortening the duration of treatment.11

Yet escharotics are still in some use in modern medicine. Zinc chloride paste is effective when carefully employed in the debridement of osteomyelitic bone12 and chronic leg ulcers (in the latter case employing the original Mohs formula, including Sanguinaria canadensis).13 In survey results published in 1991, Mohs micrographic surgeons reported using the fixed-tissue technique in fewer than 5% of patients in their care, and when using, mainly for cases with bone or cartilage involvement.14 Some modern practitioners continue to advocate chemosurgery for melanoma, citing its potential to enhance 5-year survival and prevent development of occult metastases. They highlight the destructive complications of improper application and caution against use by the untrained.15-17

Moving to the marketplace, bloodroot and sometimes zinc chloride are ingredients in a number of commercially available products, often called black salves. DermaTend is one of the most popular, and contains both. Its website claims that “it can take just one application to remove the moles or skin tags that have plagued your self-esteem for too long . . . DermaTend® is completely safe and natural and has quickly made surgery obsolete...” 18 It has over 400 customer reviews on Amazon.com.

Another product worthy of mention is Pristine Herbal Touch Wart & Mole Vanish, which is mentioned in four case reports19-22 and contains the greater celandine plant (Cheilidonium majus). The manufacturers advertise “This product does NOT contain Bloodroot . . . or Zinc butter (Zinc Chloride)!”23 It is well established, however, that Cheilidonium majus contains sanguinarine, 24,25 a bioactive alkaloid present in bloodroot. Wart & Mole Vanish is certainly an escharotic agent.

Newer on the self-treatment scene are solasodine glycosides, which were isolated from Solanum sodomaeum (the Devil’s Apple or Sodom Apple plant) by Dr. Bill E. Cham, an Australian biochemist. In 1987 he authored a small (n=28) study reporting that a cream containing a mixture of glycoalkaloids, all containing solasodine, safely and effectively induced complete clinical and histologic regression up to three years after treatment in 83% of 24 basal cell carcinomas (BCCs) and 83% of 6 squamous

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