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more deeply and disrupt the texture of the skin. The lesion on the patient in this picture began on her lip (Image 19). Acral Lentiginous Melanoma: Acral lentiginous melanoma grows on the extremities. This form, which accounts for about 10 percent of melanoma cases overall, but up to 50 percent of cases in Black people, usually starts on the hand or the foot. 5 It can be on the sole or the palm, between the fingers or toes, or under the nails (Images 20 and 21). Acral lentiginous melanoma has some unique patterns among skin cancers. It is not necessarily associated with sun exposure, since it occurs in places that are usually not sunburned. It is not associated with advanced age: Reggae singer, songwriter, and activist Bob Marley died from this disease at 36. And it is the most common form of melanoma seen in people of color. It also has a high rate of recurrence. Nodular Melanoma: Nodular melanoma creates an elevated nodule-like tumor, but it also penetrates deeply into the skin. Its prognosis may be serious because it is often aggressive and metastasizes quickly. In the example shown here, this tumor probably started as a mole, but over the course of 14 months it evolved into a much more threatening problem (Image 22). Treatment for melanoma varies, depending on the subtype, the stage at which it is found, and its location. Topical treatments along with surgical excision and lymph node dissection to look for signs of metastasis are common. Other possible therapies include biologics that help the immune system become more aggressive against cancer cells, photodynamic therapy that fills cells with a chemical that kills them when exposed to a certain kind of light, and radiation. SIGNS AND SYMPTOMS The shorthand for signs and symptoms of NMSC is "a sore that doesn't heal," which is appropriately vague; as we've 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 41 seen, these lesions can look like f laky spots, pimples, mosquito bites, and so on. And the mnemonic for melanoma signs and symptoms is ABCDE, for asymmetry, indistinct borders, mixed colors, large diameter, and evolving. In the interest of saving space, we excerpted the signs and symptoms sections of the continuing education class "Skin Cancer: Beyond the Basics" as a video to accompany this article, and it explores these patterns in more detail. (Scan the QR code on page 35.) MASSAGE THERAPY RISKS, BENEFITS What are some of the risks related to massage of a person in any stage of dealing with skin cancer—from the appearance of a suspicious lesion to post-treatment? • A massage therapist might miss an early sign that needs attention. • A massage therapist might share their observation of a suspicious lesion with careless language. This could be a breach 19. Advanced lentigo melanoma on a Black woman. Image courtesy CDC/Carl Washington, MD, Emory University School of Medicine; Mona Saraiya, MD, MPH. 20. Acral lentiginous melanoma on the sole of the foot. Note how it has extended into the toes. 21. Acral lentiginous melanoma on thumbnails. Image courtesy CDC/Carl Washington, MD, Emory University School of Medicine; Mona Saraiya, MD, MPH. 22. Nodular melanoma that arose from a mole over the course of 14 months. 19 20 21 22