Business Desk
Camouflaged – carcinomas

The Association of Registered Beauty Therapist has received a request to clarify the level of understanding that Beauty Therapists have with pigmented lesions. We have asked Ruth Nicholson – Director of NZ Laser Training Ltd to discuss the growing seriousness of “Camouflaged Carcinomas”.

A questionnaire investigating how many beauty therapists were actually able to spot a melanoma before deciding whether or not to proceed with treatment, was carried out and published in 2010 by The New Zealand Medical Journal. Although the response rate was well below what was expected (about 11 percent), the results highlighted the need for more formal training in identifying early stage melanomas and other skin cancers such as basal cell and squamous cell carcinomas. 

The questionnaire was carried out using images shown to therapists of examples of skin lesions, they were then asked a series of questions.
When asked if they would treat the “classic” superficial spreading malignant melanoma and the more subtle melanoma in situ, for the “classic” melanoma, 97 percent (n=76) would not, and three percent (n=2) were unsure. More importantly, by comparison, when shown the “subtle” melanoma, 29 percent (n=22) would have treated the lesion, 49 percent (n=38) would not, and 22 percent (n=17) were unsure.” (Source: NZMJ 16 July 2010, Vol 123 No 1318; ISSN 1175 8716).

The biggest risk occurs when a therapist inadvertently removes the warning signs so when examined by a medical practitioner, the tell-tale yardstick signs: A: Asymmetry B: Border C: Colour D: Diameter and E: Evolving - may have either been removed or altered in such a way as to reduce the warning sign and therefore the sense of urgency to treat the lesion. 

Pigmented melanomas can look like flat sun spots and to the untrained eye, blend very well with normal actinic bronzing or sun damaged skin caused due to photo ageing. IPL visible light (400nm to 700nm) is very easily attracted to the melanin in the skin lesion, it will then crust and flake off. However, we now also have technologies able to ablate, cut out or cauterise small vessels, skin tags and raised lesions such as sebaceous hyperplasias, so what are the chances that these unregulated devices are being sold to, and used by untrained and unqualified therapists? It is not just melanomas beauty therapists should be looking for, basal cell carcinomas (BCC’s) are also very common and as they typically grow slowly, these lesions are often overlooked until they start bleeding, or itching. 

As an unregulated and self-regulated industry, there is a level of expectation on beauty therapists to seek their own formal training in the area of recognition of skin cancers and skin lesions, but many do not know where to obtain this training, or are of the opinion that they are experienced enough to spot suspicious lesions. 

Professionally trained beauty therapists are doing a great job of spotting suspicious lesions and passing these people on to their medical professionals.  To the naked eye however many early stage skin cancers and melanomas are being missed, it is daunting to think that if a new questionnaire was sent out today, we could be seeing an increase in the number of untrained beauty therapists able to spot what is ok to treat and what is not.  

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