Contributed By April Neufeld, BS, LMT, NCTMB; Sandra K. Anderson, BA, LMT, ABT

Have you ever noticed strange moles or lesions on your patient's back? This is important because skin cancer is the most common cancer in the United States, with more than 3.5 million cases diagnosed annually. Since massage therapists see a great deal of client skin on a daily basis, they have a unique opportunity to recognize potential skin cancers.

This month, we at the Massage Therapy Foundation (MTF) are reporting on a study by lead author Shannon M. Campbell and colleagues called "Skin Cancer Education among Massage Therapists: A Survey at the 2010 Meeting of the American Massage Therapy Association." It was published online on August 23, 2012 by the Journal of Cancer Education, August 23, 2012.

"While non-melanoma skin cancer (NMSC) accounts for the majority of cases, melanoma is responsible for more than 75% of skin cancer deaths. Between 1992 and 2004, melanoma incidence increased 45%. In the United States, one in 52 men and women can expect to be diagnosed with melanoma in his or her lifetime. The back is the most common location of melanoma in men, while the lower legs are the most common location in women. Prognosis of melanomas is related to anatomic location. The 10-year survival rate for melanomas on the back is around 68% while the 10-year survival rate for the lower legs is 82%," write the investigators.

These statistics indicate that early detection of skin cancer is an important public health initiative. While the majority of interventions have been through detection by medical professionals, recently attention has been turned toward the ability of non-medical professionals, such as hair dressers and massage therapists, to assist with skin cancer detection. These professional massage therapists see and palpate large areas of clients' skin, including the back and legs. In addition, massage therapists may also frequently observe areas of the skin not examined by healthcare providers, such as the scalp and soles of the feet, in addition to backs and legs.

The purpose of this study was twofold. The first was to describe the skin cancer education massage therapists receive during training and second, to evaluate massage therapists' comfort levels in identifying suspicious lesions and communication with their clients about them.

The research method involved surveying two separate groups of attendees at the American Massage Therapy Association (AMTA) annual convention in 2010, in Minneapolis. One group of 179 completed the survey at a booth in the exhibit hall; the other group of 114 were participants who attended a skin cancer education workshop at the convention. Thirty-one surveys were excluded because the respondents were either from Canada or had not completed their entry-level training. Therefore, the final sample was 262.

The survey consisted of demographic questions such as gender, age and ethnicity. Participants were also asked the number of years the subject worked as a massage therapist, the state in which they practice, age range of clients, number of clients they treat per year, average number of visits per client annually, how many clients the massage therapists have recommended see a healthcare provider over the past year for a suspicious lesion, and if they ever detected a lesion on a client's skin that was confirmed to be skin cancer.

Participants were also asked to give detailed descriptions of their skin cancer education both during entry-level training and through continuing education. Descriptions included the name of continuing education courses, numbers of hours, textbooks used, academic credentials of the course instructor, types of skin cancer covered, testing and education about how and when to discuss a suspicious lesion with a client. Additionally, participants were asked to describe their comfort level recognizing and discussing a suspicious lesion with a client, as well as recommending a client see a healthcare provider for a suspicious lesion. All comfort level questions were assessed using a scale of "not at all," "a little," "somewhat," "quite" and "extremely." Frequency questions were assessed using a scale of "never," "sometimes," "usually," "often" and "always." The observed frequencies and percentages were calculated using Statistical Analysis System (SAS) version 9.2.

Results of the survey indicated that 60% of massage therapists received skin cancer education during their entry-level training, 25% received it afterwards and 16% received both during and afterwards. The majority of participants stated that melanoma and non-melanoma skin cancers were reviewed during both entry-level and continuing education courses and that when and how to discuss a suspicious lesion was also included.

Whereas 12% of participants reported a personal history of skin cancer, 72% reported knowing a friend or family member with a skin cancer diagnosis. Of those surveyed, 43% reported wearing sunscreen usually or often on sun-exposed skin and 83% reported performing self-skin exams (SSEs) at least every 1 to 2 months. Participants also reported examining their client's skin regularly, with 44% reporting that they always do so. Massage therapists who examine their own skin at least once a year were more likely to examine a client's skin. Most of those surveyed recommended at least one client see a health care provider for a suspicious lesion over the past year.

Most participants reported being quite or somewhat comfortable recognizing a suspicious lesion, being quite comfortable discussing it with the client, and being quite or extremely comfortable sharing medical knowledge and recommending the client see a healthcare provider about the lesion. Additionally, massage therapists who perform SSEs, had detected a lesion on a client that was confirmed to be skin cancer, and who examine their clients' skin on a regular basis, and who referred clients to be seen by a healthcare professional are more likely to be comfortable recognizing a suspicious lesion.

"This study has several limitations," write the researchers. "It is an observational study that does not allow for cause and effect relationships to be identified. The sample population was from a select group at a national convention and the results may not be indicative of all massage therapists. Additionally, 114 of the 293 participants completed the survey prior to participating in a workshop on skin cancer," which means they may have a greater interest in skin cancer prevention and detection. "Further studies on a larger scale with a more representative sample are needed to confirm the data. Because many years may have elapsed between training and completion of the survey, participants may have incorrectly recalled details about their education and practice. However, this study serves as a valuable introduction to skin cancer education efforts within the massage therapy community. Additional studies should focus on improving massage therapists ability to recognize suspicious lesions and collecting data directly from massage therapy schools regarding their skin cancer education."

So what does this mean? It means that massage therapists who are already checking their clients' skin for suspicious lesions are providing a valuable and necessary service, one that can potentially save a client's patient's life. Massage therapists who are unsure of their ability to detect a suspicious change on a client's skin, and are unsure of how to discuss it with the client, would definitely benefit from a course that covers this information. It could make all the difference in the world to someone they know.

Resource:

1. Campbell SM, Louie-Gao Q, Hession ML, Bailey E, Geller AC, Cummins D. Skin Cancer Education among Massage Therapists: A Survey at the 2010 Meeting of the American Massage Therapy Association. J Cancer Educ. 2012 Aug 23.

Editor's Note: Want to hear more great research all in one place? Attend the International Massage Therapy Research Conference – Presented by the Massage Therapy Foundation April 25-27, 2013, in Boston, Massachusetts. Registration is now open. Learn more at www.imtrc.org.