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w w w. a b m p . c o m . S e e w h a t b e n e f i t s a w a i t y o u . 101 Finally, a single dark black streak in the nail that comes up on to the cuticle can be a sign of melanoma. 5. SKIN CANCER The most common cause of skin cancer deaths is melanoma, which may be identified using the ABCDE criteria (see Spotting Melanoma— ABCDE Danger Signs, above), but the most common form of skin cancer is basal cell carcinoma. There are also some less common varieties that have different symptoms. "Basal cell carcinoma often presents in the form of shiny or pearly bumps, which patients think are pimples," says Elizabeth Quigley, MD, a physician in the dermatology service at Memorial Sloan-Kettering Cancer Center in New Jersey. If the lesion has been there for six months, and sometimes bleeds, that's a warning sign that it is not a pimple. Merkel cell carcinoma is typically seen in the elderly, or those who have problems with their immune system. "It often looks like a big red bump, usually greater than 5 millimeters, and usually rapidly grows over a period as short as a few weeks," Quigley says. Atypical fibroxanthoma is another skin cancer found primarily in older individuals. "There are bumps, and the skin is colored redder than your normal skin," Quigley says. "The tumor is rapidly growing, with bleeding and persistent symptoms." Squamous cell carcinoma, responsible for about 20 percent of all skin cancer deaths, has symptoms that are quite different from those of melanoma. "Squamous cell carcinoma can present as firm bumps, scaly patches, or ulcers that don't get better. The skin is red and the scale is the kind that doesn't go away with moisturizer," Quigley says. "It's different from just dry skin, and the scale is usually thicker." She says squamous cells don't rub off like normal dry skin, and the scaly patch may bleed if it is removed by pulling or picking. HEALTH-CARE TEAM Bodyworkers are often the first line of defense when it comes to the well-being of clients and their skin. Being familiar with the appearance of these early signs of disease makes you a valuable part of your clients' health-care team. John Otrompke is a health-care writer and consultant. He can be reached at ON THE LOOKOUT "Alopecia is associated with thyroid disease, but it can also be upsetting to the client in and of itself," Jorizzo explains. "The prognosis is very good if there is just one little circle, but if clients lose their eyebrows or eyelashes, or if it goes around the bottom of the scalp, the condition is more likely to be chronic." 4. SYMPTOMS ON THE NAILS A client's nails may also offer evidence of a medical condition to the alert bodyworker. "Signs on the nails include a condition called clubbing, where there's body under the cuticle that changes the angle of the nail, so that it's like an upside down V," Jorizzo says. Clubbing is sometimes accompanied by edema, and the cuticle area may feel wet. It can be a symptom of several lung conditions, ranging from chronic bronchitis to lung cancer. Pits in the nails can be a sign of arthritis or psoriasis. Pits resemble a mere dent, perhaps 1 millimeter across. Jorizzo explains, "In psoriasis, the outer layers of skin turn over very quickly, and when they come from under the cuticle, little patches fall off, so you get a pit." Spotting Melanoma—ABCDE Danger Signs Remember this list of danger signs for moles. Any of these symptoms could be indicative of skin cancer. • Asymmetry. The mole is an unusual shape, not round. • Border irregularity. The edges of the mole may be jagged, scalloped, or wavy, or very sharp in one area. • Color. The mole shows variation in color from one area to another. There may be multiple shades of black, blue, brown, red, tan, or white. • Diameter. The mole is more than 6 millimeters in diameter. • Evolving. The mole is new, or an existing mole has changed in size, shape, or color. A more informal method of spotting a suspicious mole is called the Ugly Duckling test: when a mole just seems to catch your attention for some reason. "The classic example is when a client has one thing on her that just doesn't look like any other spot on her body," explains Elizabeth Quigley, MD. "Let's say she has many black moles, but one brown mole. Or most of the client's moles are round and small, but one is big and a different shape. That is a client who should be evaluated by a physician." While the top two images look more like most people's idea of a suspicious mole, the bottom image should raise just as many suspicions. All three of these images show multiple warning signs of melanoma.

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