If you see something, say something…

A client came to me recently with a back that looked a lot like the above. Their intake form made no mention of any skin conditions or areas to avoid. Being that these growths were located in a not so visible area of the body, I wanted to probe the client further to see if (a) they were aware of the amount and irregular shape of these spots and (b) if they knew what they were. Massage protocol for many benign growths on the skin including moles and skin tags is to work around them, but with a back like the above, it would seem near impossible to avoid them. In the case of my client, the brown spots turned out to be what many doctors have dubbed “the barnacles of old age” also known as seborrheic keratosis.

This skin condition presents a lot like warts because the growths are slightly elevated off the upper layers of the skin and range in color from light to dark brown. But unlike warts the growths are not viral in origin. In fact, dermatologists are not sure what causes the condition to begin with. They can appear anywhere on the skin and often do so in middle-aged people and the elderly. They have a rough, textured hand feel, hence the “barnacles” nickname. However, because the irregular looking growths can resemble some types of melanoma, a skin biopsy is needed for a true diagnosis. See below for an extreme version.

An irritated or darkly pigmented version of the stuff…yikes.

This is why it is an important part of my job to say something when I see something. I can never assume the client is informed. I would much rather repeat something they already know, than for the sake of “spa etiquette” keep my mouth closed. The aforementioned “spa etiquette” is the hushed voice inside that says they paid to relax, not get a medical speech.

Now, assuming the dermatologist did a skin biopsy to rule out cancer, a person with seborrheic keratosis can choose to remove their growths if they are unsightly or aggravated by clothing/touch. They can be removed in the following ways:

  • Cryosurgery: This is where dermatologist applies liquid nitrogen to the growth with a cotton swab or spray gun. This freezes the growth. The growth tends to fall off within days. Sometimes a blister forms under it and dries into a scab-like crust. The crust will eventually fall off.
  • Electrosurgery and curettage: Electrosurgery (electrocautery) involves numbing the growth with an anesthetic and using an electric current to cauterize (burn) the growth. A scoop-shaped surgical instrument, a curette, is used to scrape off the treated growth. This is the curettage. The patient does not need stitches. There may be a small amount of bleeding. Sometimes the patient may only need one or the other; not necessarily both to remove the growth.

In both treatments, the skin may be lighter where the growth was removed. This usually fades with time, although it can be permanent. Most removed seborrheic keratosis do not return. However, a new one could occur elsewhere.

Since seborrheic keratosis is a local-contraindication for massage (this means to avoid the affected area), I wanted my client to get clearance from their dermatologist before applying any essential oils or lubricants onto their back. Worried that they might be disappointed (and they were at first) by not being able to have their back included in the massage, I assured them that they would still get a relaxing experience, especially when the head, neck and feet are such perfect little stress release valves. Fifteen minutes into the massage, they were out for the count and I felt that I had done my “mitzvah” (i.e good deed for mankind) for the day. Happy times.

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