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Cutaneous Squamous Cell Carcinoma: The typical presentation of cSCC is a lesion that looks more painful, or inf lamed, or alarming than BCC, although it is not necessarily painful. It usually appears on the head or face, or parts of the body exposed to sunlight, but it can also develop at sites of chronic injury and inf lammation. This type of skin cancer is the most common one for people with dark skin. This example shows an advanced cSCC lesion on the scalp of a Black man. This might have been difficult to identify in early growth because it would be covered by hair (Image 10). On light skin, cSCC often looks red and aggressive, as on the shoulder of the person shown here (Image 11). Bowen Disease: Bowen disease is sometimes called in situ cSCC, because it is usually localized and shallow. It is associated with previous exposure to human papilloma virus 16, which can also cause genital warts with a high risk of becoming malignant. It often appears on the trunk, but this photograph shows it on a finger, where it could be mistaken for eczema, psoriasis, or even an allergic reaction (Image 12). Treatment for cSCC ranges from removing early lesions with liquid nitrogen, to surgical excision, to full courses of radiation and chemotherapy. People who get repeating lesions may be prescribed a type of topical chemotherapy, which can leave the skin raw and vulnerable to infection for several days or weeks (Image 13). Melanoma Melanoma is a cancer that affects melanocytes, those cells deep in the epidermis that produce melanin, our skin's pigment. This is what creates the changes in color we see with skin tumors. But melanoma can metastasize easily, usually to the liver, bones, or central nervous system. Melanoma usually affects skin that has a history of sunburns, but it can also be found in the eye, reproductive tract, gastrointestinal tract, and sun-protected parts of the extremities. In situations where it is not related to sun exposure, the assumption is that the melanoma is caused by other factors like genetics and toxic exposures. Melanoma is threatening, but it is also highly treatable, if it is found early. The main predictive factor is the depth of lesions at the time of diagnosis. If they are less than 0.8 millimeters deep (about ¹∕ ³ inches), the prognosis is good. But if a lesion is deeper, the risk of metastasis is higher. We will look at four types of melanoma. 38 m a s s a g e & b o d y wo r k m a rc h /a p r i l 2 0 2 3 As massage therapists we can empower our clients with good information and make appropriate referrals to other professionals. Superficial Spreading Melanoma: Superficial spreading melanoma is the most common form of this disease. This version tends to spread along the surface of the skin before penetrating to deeper tissues or lymph nodes. Its appearance varies. On light skin, it might be multicolored and textured (Image 14). A very close-up view shows how the color seems to move across the lesion, with feeder capillaries (Image 15). On darker skin, this may look like an ordinary mole. As is often true for people with skin of color, the person in this image was diagnosed with a more advanced case than we usually see with light-skinned people (Image 16). Early superficial melanoma on brown skin could easily be missed. Only keen observation found this lesion before it became more threatening. (Image 17). Lentigo Melanoma: Lentigo melanoma usually appears on the face among older people, and it resembles a lentigo: an ordinary age spot. However, while age spots are typically round or oval, lentigo melanoma often shows a notched, uneven border (Image 18). In a more advanced stage, lentigo melanoma can penetrate 10. CSCC on the scalp of a Black man: the most common type of skin cancer for people with dark skin. Image courtesy Hugh Gloster, MD. 11. CSCC on the right shoulder of a light-skinned person. 12. Bowen disease on a finger. 13. Topical chemotherapy for actinic keratosis. This treatment leaves the skin very raw and sore for several days. 14. Superficial spreading melanoma. Note the scalloped borders and mottled color. 15. Close-up view of superficial spreading melanoma. Note the color differences and capillary supply. 16. Superficial spreading melanoma. Note the stitches: This is from a biopsy that identified the disease. Image courtesy CDC/ Carl Washington, MD, Emory University School of Medicine; Mona Saraiya, MD, MPH. 17. Superficial spreading melanoma, circled for biopsy. Note how subtle this lesion is. 18. Lentigo melanoma. Note the notched border on what could be assumed to be an ordinary age spot.

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