In recognition of skin cancer and melanoma awareness month, held annually each May, we report on studies that examine the role of massage therapists in skin cancer and melanoma awareness, recognition and referral.
Skin. There is nothing more essential or intimate in massage therapy than the skin, the outer covering of our being and our largest organ. Skin is the barrier between who we are and who or what is other. (Putting spiritual and philosophical considerations aside.) Conditions affecting the skin range from acne to cancer and from sunburn to Raynaud’s phenomenon.
Massage therapists are in a good situation to be vigilant and recognize changes in clients’ skin issues (and about the condition of their own as well). Certainly, in order for massage therapists to remain within proper scope of practice, they cannot diagnose but can, indeed, suggest further assessments.
Massage therapists are uniquely positioned to identify skin changes in their clients for several reasons. First, they visibly see large areas of their clients’ skin, much of which are hard to self-examine, including the back, neck and posterior legs. These areas are at a high risk for late-stage melanoma identification as they are hidden from direct sight. Second, an important characteristic of melanoma is a change in appearance.
Massage therapists often repeatedly treat the same clients, providing opportunities for the therapist to notice changes on the skin. Third, massage therapists usually have an overall interest in their clients’ health and well-being and can suggest that a client seek further follow-up if they identify potentially suspicious lesions.
Non-melanoma skin cancer is the most common form of cancer in the U.S., with more than 5 million people diagnosed each year, far exceeding breast, prostate and lung cancers combined.1 There are several different types of non-melanoma skin cancer, including basal cell skin cancer and squamous cell skin cancer. Non-melanoma skin cancers rarely spread to other parts of the body.
Melanoma, on the other hand, is an aggressive form of skin cancer. It is more likely to invade nearby tissues and spread to other parts of the body than the more common forms of skin cancer. In 2022, it was estimated that over 99,000 new cases of melanoma will be diagnosed in the U.S. and nearly 7,650 people will die of the disease.2 Melanoma is more common among individuals of light complexion and in men more than women. Unusual moles, longtime exposure to natural or artificial sunlight, such as through tanning beds, and family history can affect melanoma risks. In addition to the skin, melanoma can also occur in mucous membranes and even in the eye.
Ruth Werner, author of “A Massage Therapist’s Guide to Pathology,” adds: “While melanoma is well known as the leading cause of death by skin cancer, basal cell carcinoma and squamous cell carcinoma are not always benign. These types of skin cancer can penetrate deeply into the tissues, or use perineural invasion to spread from the skin to the central nervous system.
“This is why it is so important for massage therapists to be on the lookout for the cardinal sign of non-melanoma skin cancer: a sore that doesn’t heal,” notes Werner. “Early skin cancer can look like a pimple, scrape, ulceration, insect bite, or just a discolored spot. If a new lesion doesn’t heal, or if it comes and goes in the same place, it is important to advise clients to consult with their physician about their skin.”
What to Look For: The ABCDEs of Melanoma
A is for Asymmetry
One half of the spot is unlike the other half.
B is for Border
The spot has an irregular, scalloped or poorly defined border.
C is for Color
The spot has varying colors from one area to the next, such as shades of tan, brown or black, or areas of white, red or blue.
D is for Diameter
While melanomas are usually greater than 6 millimeters, or about the size of a pencil eraser, when diagnosed, they can be smaller.
E is for Evolving
The spot looks different from the rest or is changing in size, shape or color.
—Source: American Academy of Dermatology
In 2010, at an American Massage Therapy Association convention, a survey was conducted to describe the skin cancer education provided to massage therapists.3 Sixty percent of respondents reported receiving skin cancer education during their entry-level training. Twenty-five percent reported receiving skin cancer education after training.
“In regard to comfort levels, massage therapists were much more comfortable discussing a suspicious lesion with a client as opposed to recognizing one. This demonstrates a need to provide more education on how to detect suspicious lesions.”3 One conclusion of the study: Massage therapists might be able to serve an important role in prevention and early detection of skin cancer.
A research survey published in 2018 in the International Journal of Therapeutic Massage and Bodywork (IJTMB), the open-access publication of the Massage Therapy Foundation, further extended our understanding of massage therapists’ familiarity and comfort recognizing and discussing skin cancers.4 In this study, massage therapists were surveyed about the perceptions of their role in viewing the skin for suspicious lesions, referring clients with such lesions to a doctor, and engaging in conversations about skin cancer prevention.
Data revealed that massage therapists were more likely to discuss suspicious lesions and recommend that a client see a doctor than they were to share knowledge of skin cancer and sun safety. Although most massage therapists reported being comfortable discussing skin cancer prevention during appointments, few were engaging in such conversations.
Between 2019 and 2022, three studies were published that looked at the feasibility and effectiveness of using web-based e-training to increase massage therapists’ skin cancer knowledge, strengthen their attitudes and beliefs regarding client education in skin cancer risk reduction, and recognize suspicious skin lesions.5,6,7
Overall, these studies showed that by using web-based learning, massage therapists increase their knowledge, improve their practice attitudes (including skin self-examination) and clinical skin examination, and improve their ability to recognize a suspicious lesion both during the study and through six-month follow-up. The conclusion was that the e-training program was successful and feasible and could be delivered online with the potential of massage therapists reducing the risk of skin cancer.
In one study, respondents mentioned scope of practice frequently in the open-ended responses to researchers. In massage therapy, scope of practice varies from state to state. Still, most respondents perceived discussions about skin lesions to be within their scope of practice.
In contrast, many respondents considered sharing skin-cancer and sun-protection knowledge as outside their scope of practice; almost one-third of respondents felt it was not appropriate to discuss sun safety at any time. While any questions about massage-therapist scope of practice should be addressed to the appropriate state board or established regulating agency, “client education” is an established part of massage-therapist scope of practice as listed in the Federation of State Massage Therapy Boards Model Massage Therapy Practice Act.8
Partnering with massage therapists for skin cancer prevention shows promise in its ability to increase early-stage recognition of skin cancers; however, consideration will have to be given to how education for clients with visible sun damage fits into massage therapy’s scope of practice.
What the MTF Does for You
The Massage Therapy Foundation is a 501(c)3 providing support to the massage therapy profession. Since 1990, MTF has provided over $1 million in research grants studying the science behind therapeutic massage.
MTF founded and publishes an open-access, peer-reviewed scientific journal and provides many educational resources for massage therapists, educators and students. MTF also provides community service grants to populations in need of therapeutic massage who would otherwise lack access.
Learn more, donate, or apply for a community service grant at massagetherapyfoundation.org.
About the Author
Arthur Veilleux, PT, DPT, OCS, was certified as a massage therapist in 1987. He continued a private massage practice and teaching through physical therapy program graduation in 1993. He received a doctor of physical therapy degree in 2006 and served as an adjunct instructor at the Rutgers University Doctor of Physical Therapy program from 2012–2017. He wrote this article on behalf of the Massage Therapy Foundation.
1. The Skin Cancer Foundation, “Skin Cancer Facts & Statistics.” Skincancer.org, Jan. 12, 2022. Retrieved March 8, 2022.
2. “Key Statistics for Melanoma Skin Cancer.” The American Cancer Society, cancer.org. Retrieved March 8, 2022.
3. 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.” Journal of Cancer Education. 2013 Mar;28(1):158-64. doi: 10.1007/s13187-012-0403-7. Accessed March 8, 2022.
4. Loescher LJ, Howerter AL, Heslin KM, Azzolina CM, Muramoto ML. “A Survey of Licensed Massage Therapists’ Perceptions of Skin Cancer Prevention and Detection Activities,” International Journal of Therapeutic Massage and Bodywork. 2018 Dec 1;11(4):4-10. eCollection 2018; Dec. Accessed March 8, 2022.
5. Loescher L, Heslin K, Silva G, Muramoto M. “Partnering With Massage Therapists to Communicate Information on Reducing the Risk of Skin Cancer Among Clients: Longitudinal Study.” The Journal of Medical Internet Research, Formative Research. 2020 Nov;2;4(11):e21309. doi: 10.2196/21309. Accessed March 8, 2022.
6. American Academy of Dermatology. aad.org/public/diseases/skin-cancer/find/at-risk/abcdes. Accessed March 8, 2022.
7. Loescher LJ, Heslin KM, Szalacha LA, Silva GE, Muramoto ML. “Web-Based Skin Cancer Prevention Training for Massage Therapists: Protocol for the Massage Therapists Skin Health Awareness, Referral, and Education Study,” The Journal of Medical Internet Research, Research Protocols. 2019 May 15;8(5):e13480. doi: 10.2196/13480. Accessed March 8, 2022.
8. Federation of State Massage Therapy Boards, Model Massage Therapy Practice Act, First Edition 2014, Section 104. Practice of Massage Therapy.