Issue link: https://www.massageandbodyworkdigital.com/i/1492048
Seventeen years ago, I submitted my first article for Massage & Bodywork magazine, and it was about skin cancer. And except for a column on squamous cell carcinoma and perineural invasion that appeared in the March/April 2018 issue, I haven't returned to that topic since. And since it's been so long, we thought this would be a good time to take another look at the topic through this article, the accompanying Pathology Perspectives column, "Skin Cancer and Skin of Color," and a new continuing education course offered through the ABMP Education Center called "Skin Cancer: Beyond the Basics." Massage therapists are skin observers. It's safe to suggest we see more of our clients' skin than they do. We must do what we can to ensure our work is safe, and that includes being watchful of skin changes: color, texture, undiagnosed lesions, or any other situation that draws our attention. Then we must communicate what we observe to our clients in a way that is non-alarmist and that respects our scope of practice. That takes some skill and nuance. In this article, we'll look at what we understand about skin cancer. We'll consider who is at risk (spoiler alert: it's everyone, regardless of skin color), and who is most likely to have serious cases (spoiler alert: it's not the people who get skin cancer most often). We will discuss the three major types: basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC), and melanoma. We will provide a rich collection of photographs of several types of skin cancer in early and late stages, and on varying skin tones. And we will conclude with a discussion of how— carefully and respectfully—to bring our clients' attention to what we notice about their skin. PATHOPHYSIOLOGY Skin cells have a special property that is not shared by most tissues in the body: They are labile, which means they can grow and reproduce throughout our lifetime. This is an effective protective device, because it means that even though skin is relatively delicate, it heals quickly. However, lability comes with a cost. Every time skin is damaged and heals, cell production accelerates, and this raises the risk of genetic mutations that may become malignant. Consequently, skin cancer usually develops in one of two areas: where repeated exposure to ultraviolet (UV ) radiation has caused damage, or where a chronic sore or inf lamed area occurs—this could be a burn, pressure sore, or any other kind of prolonged, inf lamed lesion. Some evidence even suggests skin cancer may occur more commonly than average where lesions connected to psoriasis, lupus, eczema, or other skin conditions linger. Other factors that contribute to skin cancer risk include toxic exposures, especially to arsenic (but some petroleum products, pesticides, and other chemicals are also possible carcinogens), and immune suppression. This can be in the form of age, an immune-suppressing disease like HIV, or immune-suppressing drugs like chemotherapy or anti-rejection drugs used by organ-transplant recipients. An increased risk of skin cancer is an underappreciated complication of this kind of treatment. Most cases of skin cancer occur in older adults in areas exposed to sunlight: the face, scalp, ears, and whatever parts of the torso and extremities are exposed while working or relaxing in the sunshine. But both nonmelanoma skin cancer (NMSC) and melanoma occasionally appear in places that are not exposed to the sun: between the toes, on the bottom of the foot, inside the digestive or reproductive tracts, or in the groin. When that happens, it is most likely related to genetics, chronic injury and inf lammation, suppressed immunity, and other non- UV light-related factors. STATISTICS AND SURPRISES Skin cancer is the most common type of cancer in humans, although it's not the leading cause of death by cancer. Your chance of developing skin cancer, if you haven't had it already, is about 1 in 5. If you have had skin cancer before, your chance of having it again, especially a more aggressive or threatening type, is substantially higher. 34 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 S