Skin Deep


With summer just around the corner, people all around the country start to trade in their coats and jeans for T-shirts and shorts as they gear up for all the warm weather activities they’ve been missing. Unfortunately, while many Americans remember the beach balls and sunglasses, they forget something even more important—sunscreen.

According to the American Cancer Society, more than 3.5 million Americans are diagnosed with skin cancer every year. Skin cancer is the most common form of cancer in the United States and is caused by extended exposure to ultraviolet (UV) radiation. The American Academy of Dermatology (AAD) estimates that more than 8,500 people in the U.S. are diagnosed with skin cancer each day, and 1 in 5 Americans will develop skin cancer in their lifetime.

The No. 1 risk factor for skin cancer is extended exposure to UV rays, which means exposure by being out in the sun or underneath a tanning lamp. After that, pale skin, multiple or unusual moles, and family history all play a role. Finally, prior severe sunburns and a weakened immune system can be contributing factors as well.

When discovered in the early stages, however, skin cancer is highly curable—and massage therapists are in the perfect position to help with early detection when they know what to look for. Read on to learn more about how you can help your clients.

Different Types of Skin Cancer

There are three primary forms of skin cancer: basal cell, squamous cell and melanoma. Basal cell carcinoma is the most common type of skin cancer. According to the American Cancer Society, about 8 out of 10 skin cancers are of the basal cell variety.

Basal cell carcinoma develops after years of frequent UV exposure, so it’s most commonly found in areas of the body that receive a lot of sun, such as the head, neck and arms. However, basal cell carcinoma can form anywhere on the body.

Basal cell carcinoma will usually form as a flesh-colored, pearly bump, except on the chest and back, where it is often a flat pink or white patch of skin. Although basal cell carcinoma rarely spreads to other parts of the body, early discovery and treatment are still important. Untreated basal cell carcinoma can spread to surrounding tissue and grow into the nerves and bones, causing damage and disfigurement.

Squamous cell carcinoma is less common than basal cell carcinoma, accounting for roughly 2 of 10 skin cancer diagnoses, but it’s still the second most common form of skin cancer. Similar to basal cell carcinoma, squamous cell carcinoma develops after frequent UV exposure, most commonly on the rim of the ear, face, neck and arms. This type of skin cancer is also quite common on the chest and back.

Squamous cell carcinoma will often form as a firm red bump, scaly patch or a sore that heals and then re-opens. If left unchecked, the cancer can grow deep into the skin and cause damage and disfigurement. Although still fairly uncommon, this type of skin cancer also has a slightly higher chance of spreading throughout the body.

Melanoma is the deadliest form of skin cancer. This cancer begins in the melanocytes—the cells that make the pigment known as melanin, which gives skin its color. Melanoma can be either noninvasive or invasive, although when left untreated, noninvasive melanoma can become invasive. Noninvasive means that the cancer is confined to the top layers of the skin, whereas invasive melanoma has already penetrated deeper into the skin.

The AAD estimates that roughly 145,000 new cases of melanoma will be diagnosed in 2016, with basal cell carcinoma basal cell carcinoma squamous cell carcinoma melanoma nodular melabout half of those cases being invasive. Good outcomes are dependent on melanoma being detected early, as the average fiveyear survival rate for those who discover the disease early—before the cancer spreads to lymph nodes—is 98 percent. Survival rates drop to 63 percent if the cancer has spread to regional lymph nodes, and to just 17 percent if it has spread to distant lymph nodes or other organs. “Melanoma is highly curable when detected early; however, advanced stages of melanoma can metastasize to the lymph nodes and internal organs and lead to death,” says dermatologist Amanda Friedrichs, M.D. “It is currently estimated that 10,130 people will die from melanoma in 2016.”

Melanoma frequently develops in a mole or suddenly appears as a new dark spot on the skin. Because melanoma forms from the melanocytes, spots are usually brown or black, but they can be pink, tan or white. This form of skin cancer can develop anywhere on the body, but is most common on the chest and back in men, and on the legs in women.

How to Identify Melanoma

The most reliable way to spot and identify possible melanoma is through the ABCDE method, which details all the changes between a normal benign mole and melanoma.

Asymmetry. If you draw a line through the middle of a benign mole, both sides will look similar. Asymmetry on either side of a mole is one warning sign of melanoma.

Border. Moles with uneven, scalloped or poorly defined borders should be examined.

Color. The color of melanoma will differ from one area to another. There may be shades of tan, brown, black and even red, white or blue.

Diameter. Melanomas are generally greater than 6mm, the size of a pencil eraser, but they can be smaller.

Evolving. A mole or skin lesion that looks different from the rest, or is changing in size, shape or color, may indicate melanoma.

What Can Massage Therapists Do to Help?

As is always the case, massage therapists cannot diagnose, so you absolutely must stay within your scope of practice when talking with your client about skin cancer. But know, too, that you are in a great position to recognize changes in your client’s skin and help refer your client so they can be evaluated. “All massage therapists should be knowledgeable in the ABCDEs of melanoma,” says Dr. Friedrichs.

Knowing how and when to bring up the topic of a suspicious lesion is also important. Typically, massage therapists should wait until the session is over, when they can have a face-to-face conversation with the client. According to Dr. Friedrichs, you can say something as simple as that you noted a spot on the client’s skin (you should be specific here) and recommend they see a board-certified dermatologist for further evaluation. “I recommend massage therapists develop a relationship with local dermatologists in order to provide contact information for their clients,” she adds.

The truth is, massage therapists are in a great position to help with efforts in the early detection of skin cancer. Having a good understanding of what to look for, as well as how you should approach clients with information about skin changes you notice, can help save lives. “Only 20 percent of individuals look at their backs to screen for skin cancer on a yearly basis,” Dr. Friedrichs says. “Many aren’t ever examined by a physician. You have the unique opportunity to view these areas and help detect skin cancers at their earliest stages, and early detection saves lives.”


Protecting Yourself Against Skin Cancer

Protecting yourself from skin cancer risks is as important as helping your clients. Following are a few helpful tips to help you enjoy the sun safely.

Apply a broad-spectrum, water-resistant, SPF 30+ sunscreen every day. The simple action of putting on sunscreen before going outside can go a long way toward protecting your skin, especially on your back. According to the American Academy of Dermatology (AAD), 37 percent of people rarely or never apply sunscreen to their back, and 43 percent rarely or never ask someone else to apply sunscreen to their back. Finally, don’t forget to reapply approximately every two hours if you’re outside for an extended period of time, or every hour if sweating or swimming.

Wear protective clothing and seek shade. Keep your skin covered and stay out of the sun’s direct rays whenever possible. While heat does play a role when considering what protective clothing to wear, a long-sleeved shirt, pants, a wide-brimmed hat or sunglasses are all recommended. Remember, the sun’s rays are strongest between 10 a.m. and 2 p.m., and your shadow can help identify when you should get out of the sun. If your shadow is shorter than you are, seek shade.

Use extra caution near water, snow and sand. All of these surfaces reflect the damaging rays of the sun and can lead to skin damage—even when you assume you are safe. Remember that even if it’s cloudy or cold, you still need to protect your skin.

Avoid tanning beds. The ultraviolet light from tanning beds is just like the sun and can also cause skin cancer. “The United States Department of Health and Human Services and the WHO’s International Agency of Research on Cancer panel have declared UV radiation from the sun and artificial sources, such as tanning beds and sun lamps, to be a known carcinogen,” explains board-certified dermatologist Amanda Friedrichs, M.D.

Know your spots. Finally, know what your skin looks like, as well as where any moles or other marks are located, and keep tabs on them using the skin self-examination protocol below, recommended by the AAD. If you notice anything changing, growing or bleeding on your skin, consult a dermatologist.

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