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be done with some care, a topic that is addressed in "Skin Cancer: A Closer Look." In addition to the resources listed, there are three good resources that collect images of skin diseases on skin of color. While these resources don't focus on cancer specifically, the whole topic of skin diseases as they present on dark skin is hugely underaddressed, and I want to encourage all massage therapists to bookmark and use these resources regularly: • Brown Skin Matters: brownskinmatters. com • Mind the Gap: mindthegap • Skin Deep: gallery In my opinion, every person who has skin—regardless of its tone—should have some knowledge on skin cancer. Because our main interface with clients is by way of their skin, and because we are also self- care advocates, massage therapists have the opportunity, and possibly even the obligation, to observe, make note, and educate clients about skin cancer and its risks. Through our early detection, we can participate in bringing the number of advanced skin cancer cases down. Ruth Werner is a former massage therapist, a writer, and an NCBTMB- approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology (available at booksofdiscovery. com), now in its seventh edition, which is used in massage schools worldwide. Werner is available at L i s te n to T h e A B M P Po d c a s t a t a b m m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 73 PATHOLOGY PERSPECTIVES • People with skin of color often don't recognize themselves as being at risk for skin cancer, and so they may not make a habit of using sunscreen, wearing protective clothing, or doing full-body skin checks. Awareness of the risks of skin cancer within this population is low compared to White people. • People with skin of color may have less access to medical care, and/ or they may feel less heard, less understood, or taken less seriously by the medical community—which is, in fact, the case—partly because . . . • Medical providers often are under- educated about skin cancer and other skin problems in people with skin of color. This problem is made worse by having limited resources in medical education that address this issue. It all boils down to two main issues: health-care access and awareness. People with skin of color (and all people, for that matter) need to be able to access care from educated providers who take their concerns seriously. And those providers and their patients need to become more aware of the risks, early signs, and the importance of preventive measures for skin cancer. If those changes took place, I believe skin cancer outcomes would not stand out as an example of systemic racism in our health- care system. WHAT DO WE DO WITH THIS INFORMATION? We become advocates for excellent skin cancer vigilance and prevention. We become educated about what skin cancer looks like, not just on White skin, but on all skin tones. We encourage all our clients, of every skin tone, to use good preventive measures against skin cancer. And we speak up—carefully—when we see changes on our clients that require attention. That communication must We see evidence of this fact in the photographs in the "Skin Cancer: A Closer Look" article (page 32). Almost without exception, if a person of color had skin cancer, they were photographed at a more advanced stage than a White person with the same condition. This isn't a matter of my cherry-picking images. It's a simple fact: People with skin of color are diagnosed later, and consequently photographed later, compared to White people. As a result, they have riskier, more complicated, and less successful treatment experiences compared to White people. Two key statistics cited in that article support this: Cutaneous squamous cell carcinoma is 10 times more likely to metastasize in Black patients, and the five-year survival rate for White people diagnosed with melanoma is 93 percent, but for Black people, it is 71 percent. This is not because skin cancer is more aggressive in some people than others. It is, in part, a ref lection of disparities in health- care access and skin cancer awareness in both patients and health-care providers. HOW MTs CAN HELP As skin observers and advocates for good self-care, it is our responsibility to be aware of this: The risks connected to late diagnosis and treatment are greater for our clients with dark skin than for our White clients. But why would this be true? A few issues contribute to this problem: • Subtle changes in skin tone, especially when the skin gets darker, can be hard to track on dark skin, especially when they occur in places that are hard to see, like between the toes or on the sole of the foot. (And acral lentiginous skin cancer, which has this pattern, is the most common form of melanoma among people of color.)

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