Issue link: https://www.massageandbodyworkdigital.com/i/1492048
L i s te n to T h e A B M P Po d c a s t a t a b m p.co 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 43 of scope of practice, and it could cause unnecessary alarm for the client. • A massage therapist might, through not paying attention or recognizing signs and symptoms, rub directly on a tumor. Whether that actively promotes metastasis or not is impossible to predict, but it's still not a good idea. • Some cases of skin cancer are treated with topical chemotherapy or surgical excision. Both at least locally contraindicate massage while the skin is compromised and vulnerable to infection. • Other side effects of cancer treatment require advanced education in oncology massage therapy for best safety practices. This is not to suggest that massage therapy has no benefits for people who are dealing with skin cancer. Our work can be helpful in several ways: • We can be an early warning system. This is especially true with clients we see over time, because we can take notes and track changes in what we observe. • Skilled massage therapy can improve sleep, ease anxiety, reduce pain, and offer support during a challenging time. Again, this requires advanced education to be safe and effective. • Clients who have successfully treated their skin cancer are usually good candidates for massage. Some follow- up questions about lymph node involvement, surgical scarring, or other lingering effects of their cancer and treatment are called for, of course. COMMUNICATION GUIDELINES How best to communicate our findings or observations to our clients without creating unnecessary fear is a nuanced skill. There are many good ways to do this, and a few bad ones. Waking up a dozing client with, "Ew, that's a nasty basal cell carcinoma you've got there!" or, "Wow, look at that. That could be a melanoma!" are examples of messages that miss the mark. The first step in communicating what you observe is to choose your timing. If your client is awake, alert, and chatting with you, then it's probably fine to mention what you see during the session (with careful language), especially if it means you want to change plans in your massage. But if your client is in one of those gorgeous transcendental states that only massage can induce, or even just having a lovely catnap, then it is best to wait until your post-session conversation to bring up what you noticed. This can be done with a simple construction: State your observation, using descriptive, non-alarmist language. "I see a bump here that I haven't noticed before." "Tell me about this brown mark." "Have you ever noticed this spot on your foot?" Other non-scary descriptors might include "raised area," "blemish," "different texture," and so on. Inevitably, clients will ask, "What do you think it is?" and this is where we must refer them firmly to their primary care physician or dermatologist. As we saw in the photographs, sometimes BCC looks like melanoma. Sometimes melanoma is almost invisible but needs attention. We are not capable of making that call. So, it is appropriate to say something like, "I can't say what this is, but I do think it would be great to ask your doctor about it." This must be followed by a plan of some kind: You will make a note in their chart; the client will consult their doctor; or maybe you can take a picture of what you see (using the client's phone, not yours) so they can track any changes over time. A CALL TO ACTION Skin cancer kills thousands of Americans each year, and every one of those deaths could be avoided. As massage therapists, we can participate in early detection of skin cancer growths, empower our clients with good information, and make appropriate referrals to other professionals. I have provided some links to resources to find free early screening events and for low-cost skin cancer care cancer care in the list of resources on page 40. Our health- care system creates many barriers, but massage therapists can help reduce some of those hurdles through observation, careful language, and appropriate referrals. Notes 1. American Academy of Dermatology Association, "Skin Cancer," accessed December 26, 2022, www.aad.org/media/stats-skin-cancer. 2. Skin Cancer Foundation, "Skin Cancer: Facts & Statistics," accessed December 27, 2022, www.skincancer.org/skin- cancer-information/skin-cancer-facts. 3. Maryann Mikhail, "Skin Cancer in People of Color: Statistics, Pictures, and Prevention," GoodRx Health, updated September 1, 2022, www.goodrx.com/conditions/skin-cancer/skin- cancer-people-of-color-pictures-prevention. 4. Skin Cancer Foundation, "Skin Cancer: Facts & Statistics," accessed December 27, 2022, www.skincancer.org/skin-cancer- information/skin-cancer-facts; American Academy of Dermatology Association, "Skin Cancer," accessed December 26, 2022, www.aad.org/media/stats-skin-cancer. 5. Deborah S. Sarnoff, "The Skin of Color Revolution in Dermatology: Crucial Lessons Learned," Carcinomas and Keratoses 2, no. 3 (2020), accessed December 29, 2022, www.carcinomasandkeratoses. org/the-skin-of-color-revolution-in- dermatology-crucial-lessons-learned. 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 ruthwerner.com. VIDEO: "SKIN CANCER SIGNS AND SYMPTOMS" 1. Open your camera 2. Scan the code 3. Tap on notification 4. Watch!