Massage & Bodywork

MARCH | APRIL 2018

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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 45 PATHOLOGY PERSPECTIVES easy to treat. Jan's experience of squamous cell carcinoma with perineural invasion demonstrates that this is not always true. And that common misconception prompts her to share an important message to massage therapists: skin cancer isn't easy. If Jan hadn't been so diligent about her skin checks, she could have been in serious danger. As it was, she went through a lengthy and taxing treatment that put her at risk for system-wide infection and worse. THE ROLE OF MASSAGE THERAPISTS Massage therapists have a unique privilege: we see more of our clients' skin than they do themselves, and with regular clients, we see that skin over the course of time. With that opportunity comes a responsibility: we need to inform our clients when we see something that might require some attention. How we bring it to their attention is the tricky part. I love what Jan's hairstylist said. How simple, how ordinary, how lifesaving! In the years that I have been a pathology educator, I have heard from many massage therapists with their versions of this story: a time when they recognized something on their client's skin and it turned out to be an important finding. A couple of research studies highlight that the medical field appreciates our role as "first responders" in the context of skin cancer. But this role requires that we become deeply familiar with the forms and presentations of this disease, and that we become as comfortable as possible with expressing our concerns, while staying within our scope of practice. It is not appropriate to say, "Wow, sure looks like a big basal cell carcinoma here!" when we massage someone's scalp, but if we see or feel a suspicious change in the tissue, it is appropriate—and important—to say something like, "I notice something here that you might want to show your doctor." How do you start this dialogue? Do you need some practice with a willing colleague? When this issue comes up, as it inevitably will, I hope you conduct these conversations with compassion and courage. What you say could save a person's life. Ruth Werner, BCTMB, is a former massage therapist, a writer, and an NCBTMB-approved provider of continuing education. She wrote A Massage Therapist's Guide to Pathology (Lippincott Williams & Wilkins, 2016), now in its sixth edition, which is used in massage schools worldwide. Werner is available at www.ruthwerner.com. The complications of her cancer treatment became a profoundly emotional experience. Jan was frustrated with the pain that didn't seem to have an end in sight, plus a constant burning sensation on the outside of her mouth, along with crushing fatigue and the loss of the ability to eat without pain. THE BEST OUTCOME Now, several weeks later, Jan's mouth is mostly healed, but she still considers eating regular food a daily trial— and sometimes a triumph. She uses a Chinese burn cream on the outside of her lip. The affected skin is darker brown than the surrounding area, and it feels dry, swollen, and immovable "like an accordion that is stuck shut." It is safe to touch her lip, and although it is painful to manipulate it, she does so regularly to work on improving the quality of the tissue. Jan's last follow-up appointment was positive. Her oncologist is confident that the cancer has been stopped, and she has a clean bill of health. In the meantime, she has no facial hair in the radiated area, and her salivary glands may never recover. But this won't slow her down. In the coming year, she and her partner plan to travel to Mexico, Israel (conditions permitting), Denmark, Sweden, Norway, and England. Jan is a devoted lover of life, and thanks to her diligence and her health-care team, she has a lot more to enjoy. "YOU'RE LUCKY IT'S JUST SKIN CANCER" What are the takeaway messages from all this? Jan was wise to track any changes in her skin and to have regular appointments with her dermatologist. That's a recommendation many of us can follow and make for our clients in similar circumstances. Jan's first lesions weren't noticed by her massage therapist, but a lot of people's are. And her hairstylist's language ("You have some spots I've never noticed before. You might want to have them checked out.") was perfect: clear, nonalarmist, without a hint of diagnosis. Jan didn't use massage therapy to help her cope with her ordeal, but a lot of people do. And it's obvious from this story that special accommodations for pain, fatigue, and painkillers would be necessary. What Jan did hear from some massage therapists was troublesome: "You're lucky it's just skin cancer." I hope that what we've described here makes it clear that "just skin cancer" is not an accurate way to describe what Jan has been through. There is a prevailing attitude that skin cancer is a trifling problem, nonthreatening, and

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