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42 m a s s a g e & b o d y w o r k m a r c h / a p r i l 2 0 1 8 education PATHOLOGY PERSPECTIVES This edition of Pathology Perspectives is a departure from my typical offering. I usually start with a description of some pathologic condition, and then go through demographics, etiology, and signs and symptoms, and I finish with implications for practice, often with a call to action for massage therapists. But in this article, we are going to take a very brief look at a subtype of squamous cell carcinoma, and then track in detail the progress of the condition and treatment with a person who has generously shared her story with us. Squamous Cell Carcinoma More Than Meets the Eye By Ruth Werner SQUAMOUS CELL CARCINOMA: A QUICK REVIEW Squamous cell carcinoma (SCC) is cancer that affects the keratinocytes, just superficial to the basal layer of the skin. It is diagnosed in about 1 million Americans each year. Usually SCC lesions are simply removed with liquid nitrogen or a shallow incision, and no further treatment is needed. But in some circumstances, SCC has a potentially dangerous pattern that I had never heard of before I began developing this article: perineural invasion. Perineural invasion (PNI) is a feature of a small number of cancers that affect the face and head. In this situation, cancer cells use motor or sensory nerves to travel and possibly metastasize to other locations. This pattern is almost exclusive to cancers that affect the face and head; most other forms of cancer use blood, lymph, peritoneal fluid, or direct contact to move to new locations. PNI occurs in approximately 5 percent of diagnosed cases of SCC, and it is associated with an increased risk for cancer recurrence, local and distant metastasis, and a poor prognosis. PNI can be found in a few ways. The clinical presentation is that a person might describe symptoms of

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