Issue link: https://www.massageandbodyworkdigital.com/i/943527
A B M P m e m b e r s e a r n F R E E C E a t w w w. a b m p . c o m / c e b y r e a d i n g M a s s a g e & B o d y w o r k m a g a z i n e 43 neuropathy: numbness, tingling, pain, or weakness in some area of the face. The histological pattern shows abnormal cells inside the perineurium (the wrapping around nerve cell fibers). One of the tricky things about PNI, however, is that it can cause "skip lesions"—that is, these depositions of abnormal cells are not necessarily continuous. When SCC is diagnosed along with PNI, the treatment likely to yield the best outcome is Mohs surgery (a procedure that removes tissue in layers until a clear margin has been established), followed by radiation. Sounds simple, right? It isn't. LEADING UP TO DIAGNOSIS If you are involved in the world of massage therapy or bodywork, it's safe to say that you have benefited from the work of Jan Schwartz. Jan is a former massage therapist, educator, and volunteer for numerous national and international organizations dedicated to massage therapy and integrated health care. The short list of Jan's volunteerism includes stints on the boards of the Massage Therapy Foundation, the Commission on Massage Therapy Accreditation, and the Academic Consortium for Complementary and Alternative Health Care (now the Academic Collaborative for Integrative Health). Jan was also the cofounder of online education provider Education and Training Solutions, LLC. Jan is a mature, fair-skinned Caucasian woman. She grew up on the Jersey Shore, when laying out in the sun coated with baby oil was favored over the scrupulous application of SPF 90 sunscreen. She has lived in Tucson, Arizona, for 25 years, where she enjoys outdoor activities, including swimming, gardening, and hiking. All these factors: her age, a long history of sunburns, and current location and habits, put Jan squarely in the high-risk group for various types of skin cancer. For this reason, she has always been diligent about twice-yearly visits with her dermatologist. Jan has a long history of minor skin cancer incidents. But about six years ago, she had lesions on her scalp that were first observed not by her or her dermatologist, but by her hairstylist. "You have some spots I've never noticed before," he said. "You might want to have them checked out." That remark led to more invasive treatment: Mohs surgeries on her scalp and forehead. Her most recent bout with skin cancer was the most serious to date, and Jan—ever the educator—invited me to share her story, so that others might learn from her experience. It began when Jan noticed a suspicious change in the skin close to the center of her upper lip in July 2017. She had a dermatology checkup scheduled for early August, so she didn't rush to make a new appointment. In fact, many of us saw Jan during that time, as we celebrated her retirement and many contributions to the profession at the Alliance for Massage Therapy Education meeting in Tucson. But during that five-week period, she saw the lesion change rapidly. By the time she saw her dermatologist, it was a palpable bump of about a quarter-inch, with scaly, slightly darker skin than the surrounding area. It was not painful or itchy. It would have been easy to ignore or miss. But her dermatologist diagnosed it as a squamous cell carcinoma, a common type of skin cancer with a small-but-not-zero risk of metastasis. Jan saw a plastic surgeon, who performed a Mohs- like surgery. The margins of the lesion were clear, and the surgeon was so skilled that the scar tissue was almost imperceptible: all in all, an excellent outcome. But the following week brought some bad news. When Jan went to have her stitches removed, she learned that the analysis of the excised tissue showed signs of perineural invasion. This means the cancer could travel along nerve fibers from the skin and show up in other disconnected areas in the head or neck, including in the brain. The safest option was to follow surgery with radiation. Lots of radiation. Her oncologist predicted that 30 doses, given five times a week for six weeks, would probably take care of it. Perineural invasion occurs in approximately 5 percent of diagnosed cases of SCC, and it is associated with an increased risk for cancer recurrence, local and distant metastasis, and a poor prognosis. digital extra page 116