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[00:00:55] Episode Intro and Guest Bio

[00:00:55] S4OM/S4OE: Good day, everyone. Welcome to another episode of [00:01:00] Collaborative Connections, a space for sharing and learning sponsored by the Society for Oncology Massage and the Society for Oncology Aesthetics. My name is Erica Clinton, and I will be your host for this episode. Today’s episode is the third in our skin cancer awareness series, and we have with us today Morag Curran, oncology aesthetician, educator, and S4OM board member. So I’m gonna start off by telling you a little bit about her, and it’s a lot a bit about her because she’s an amazing person. With more than 30 years of practice, Morag Curran is one of the most recognized voices in oncology aesthetics. It’s a field she helped define long before it had a name. As the founder of the Soul Silo, she has built an integrated professional ecosystem that weaves clinical rigor, [00:02:00] nervous system science, and deep human presence into every aspect of aesthetics education and care. Morag pioneered oncology aesthetics education in 2007 and has been teaching it ever since, shaping how the profession understands and serves people living with and beyond cancer. Morag is an accomplished author and continuing education presenter. Her aesthetics trainings help professionals to develop emotional regulation and body presence and the non-verbal attunement that defines truly whole person care. Her practice has been shaped by a lifetime of attuned non-verbal communication, including navigating a career with hearing impairment, giving her an exceptional ability to read the body’s language and hold space for clients navigating the hardest chapters of their [00:03:00] lives. She is an unapologetic advocate for fair professional compensation in oncology aesthetics, challenging the industry’s tendency to treat skilled certified care as a donated service. We are so, so grateful to have you with us today. Thank you, Morag, for taking the time to join us. How are you?

[00:03:22] Morag: Oh, you’re welcome. Thanks for having me. That was a glowing testimonial, by the way.

[00:03:28] S4OM/S4OE: Well, you are an impressive, impressive person. To be kind of the founder of something and the champion of a field that clearly deserves to be recognized is something we all should herald. And I oftentimes find that people like yourself kind of get lost in the history of the field. And I’m glad we can kind of highlight you today as we talk about [00:04:00] oncology, aesthetics, and skin cancer.

[00:04:01] Morag: Oh,

[00:04:02] S4OM/S4OE: Thank

[00:04:02] Morag: awesome. Thank you

[00:04:03] S4OM/S4OE: you. You’re welcome.

[00:04:05] Why Aestheticians Spot Skin Cancer

[00:04:05] S4OM/S4OE: So I always like to start off with a bit of education for our listeners. Let’s just assume everybody’s kind of at the same place and want some clarity about oncology, aesthetic, and skin cancer. So why does skin cancer awareness belong in the aesthetician’s scope, not just the dermatologist’s?

[00:04:27] Morag: This is something I’ve been fighting for right from the beginning. Look at what we do, whether we’re a massage therapist or an esthetician. We have people coming into the spa voluntarily. A person diagnosed with cancer goes to the hospital, it’s not a volunteer visit. It’s a visit c- that they’re driven by because of the disease.

[00:04:51] Morag: It’s invasive, it’s very clinical, it’s very medical, it’s very intimidating. We have an environment, for the most [00:05:00] part, that is very welcoming, very s- much softer, yet has a clinical side to it. And we are opening up people From so many levels, from mental from the mental side. So we look at body, mind, spirit.

[00:05:16] Morag: We’re not just focusing on a disease like a medical professional would. We’re also looking at the outcomes for a person from a psychological perspective. Of course, people come to us for skin related issues. Perhaps they’re coming to us for relaxation. Some of them might be coming to us for symptom relief, which really falls more into the massage therapy side, but there’s still massage done in aesthetic treatments as well.

[00:05:41] Morag: So people have a tendency to also share information with us more voluntarily, and by sharing information and by trusting us we also are seeing people in very much a vulnerable state. We see them emotionally vulnerable. We see them [00:06:00] physically vulnerable. And so we are exposed to the bodies that certainly sometimes, unless they have to see a doctor for a specific lesion on their body or something like that, we have the tendency to see people that, i- in any part of the body actually that we’re working at So I think that puts us in a very strong position to really try and advocate more for recognizing skin cancer and creating more awareness around this because there are still too many people that “Yeah, yeah, tomorrow’s another day.

[00:06:36] Morag: I don’t need sun protection.” And so the, it- we have to step into a role of responsibility in some way because just by the way that we address this the c- we need to make it so that the client takes us more seriously and says, “You know what? I do need to get this checked out.”

[00:06:56] Morag: Now, here in Canada, we really [00:07:00] do have a problem with regards to dermatologists.

[00:07:04] Morag: There are not enough of them for us, and my biggest thing is, you know what? Don’t make excuses. I know it’s gonna cost you a little bit of money. Hop over the border, go down to United States, and book yourself in with a dermatologist there. But coming back to aestheticians and massage therapists, you’re seeing pretty much the whole body.

[00:07:22] Morag: Aestheticians, we’re seeing parts of the body. Depending on where you are in the world, you might see the whole body as well. But, just little areas like the back of the hairline, in the ear on the top of the ear on your back someplace, behind your knee the back of your legs. These are areas that people don’t look at.

[00:07:40] Morag: And so when somebody comes to us and they’re trusting us to look at them like that, it really is a responsibility for us to actually encourage them to go for checkups. And you know what? Despite the fact GPs might say, “Oh, yeah, just a wait and see type of thing,” push for it. Push [00:08:00] for that biopsy

[00:08:01] S4OM/S4OE: Mm-hmm. No, that’s very important. And as you were talking, I was like, right, you could see your esthetician once a month or once every couple weeks, where if you, even if you have a regular dermatologist, you’re probably gonna see that person once a year.

[00:08:18] S4OM/S4OE: So the opportunity for intervention and early intervention is really in the hands of the esthetician

[00:08:26] Morag: Absolutely.

[00:08:27] Speaking Up About Suspicious Lesions

[00:08:27] Morag: And you know what? Being silent about something that’s unusual is doing a disservice to your client

[00:08:33] S4OM/S4OE: Yes, very much so. As hard as it may be to say, right? It’s always difficult to have to navigate that conversation, but not saying something is, I would even say, unethical

[00:08:47] Morag: Correct. I absolutely agree with you. I mean, and there are little ways to do it. So you can actually almost make it light-hearted in the sense that, “You know what? I’m gonna take a photograph of this [00:09:00] lesion, and I want to take it every time you come here. I want to take a picture of it, and I want to see how it’s changing.”

[00:09:07] Morag: And perhaps the changing of the lesion is going to make people more aware, because I have realized also from aesthetics over the years, people just accept changes without being alarmed with the changes. For example, I met somebody quite a few years ago when I was doing a presentation on skin cancer, and my eyes kept gravitating to this man’s forehead because he had a, an open wound there.

[00:09:34] Morag: And finally, I couldn’t resist it anymore, and I said to him, “How long have you had that sore on your face for? ‘Cause it’s quite open and raw.” And he goes, “Oh, I’ve had it for six months.” And I said, “Well, don’t you think you need to get it checked out?” And he said, “Actually, I did. I had it checked out last week, and it’s a squamous cell carcinoma.”

[00:09:54] Morag: But this is what I’m saying. He accepted that anomaly as [00:10:00] normal. It’ll heal up sometime. Okay? And so this is the same thing that’s happening with moles. If there’s changes to the mole, “Ugh, it’s just changing,” or if it’s itchy, “Oh, I’ve just gotten a temporary itch.” Or if somebody says to me, “Well, I’m having a headache every day.”

[00:10:16] Morag: And I’m like, “That’s not normal.” “Well, yes it is. I’ve had headaches for years.”

[00:10:20] Morag: Okay, that’s not normal. So this is what I’m saying. People are very accepting of changes on their skin and on their body, and they don’t take seriously what the long-term repercussions are gonna be. It’s like teenagers, even when they come here and they do equine therapy with us, I said to them, “You know what?

[00:10:38] Morag: You guys really need to wear sun protection.” “No, we’ll be fine. We don’t need sun protection.” But you know what? My voice rings in the back of their mind when they’re, like, 50 years old and they have half their nose removed, or they got a big chunk of, tissue taken out of their body, and they remember, “Oh, maybe we should have paid attention to it then.”

[00:10:56] Morag: So I think that’s a really strong thing. People [00:11:00] forget and don’t pay attention to the changes to their skin.

[00:11:04] S4OM/S4OE: Yes. And they’re willing to ignore so much, right? Even things that, that clearly indicate something is not right.

[00:11:13] S4OM/S4OE: Um-

[00:11:14] Morag: Absolutely. But you know what? And it’s the same thing, Erica. It’s people in Africa, they’ve got darker toned skin, “We don’t need to use sun protection.” Well, of course you’ve got more protection than we do with the lighter skin. You do. But let me tell you, it’s sometimes harder to pick up when there’s anomaly there.

[00:11:33] Morag: So

[00:11:34] Morag: wear

[00:11:35] S4OM/S4OE: will kill you

[00:11:36] Morag: take care of your skin

[00:11:38] S4OM/S4OE: Yeah. Um, there’s a lot, there’s a lot of education that I feel, I guess, needs to happen.

[00:11:44] Education Gaps and Sunscreen Myths

[00:11:44] S4OM/S4OE: So let’s talk about aestheticians and education. What do you think is the most common gap in their understanding of skin cancer risk? What don’t they get in foundational education?

[00:11:57] Morag: A lot of them, there’s a lot of [00:12:00] people, first of all, that say that they have never seen somebody with skin cancer. So a lot of them, and what I’m trying to say to aestheticians, particularly like when I’m talking to aestheticians in training at school level learn about the non- like, your benign lesions on the skin.

[00:12:17] Morag: Know what a mole looks like. Know what sebaceous hyperplasia looks like. Know what skin tags look like. Know what your benign lesions are. And any time you see something that looks suspicious, then address it. I find that the schools seem to and appear to teach about your sun protection. They talk about being in the sun early morning or late in the afternoon. They talk about wearing clothing. They talk about slight changes to the skin, but it’s not done in depth. And then a few years ago, there was this big scare out there in the industry where everybody was hitting the bandwagon about sun protection, and use an SPF 60 [00:13:00] and the higher … But nobody focuses on the reapplication of the product You can’t just put sun protection on in the morning and be out in the sun for the full day.

[00:13:12] Morag: The number there has a meaning, and you have to reapply. So that’s the one thing that people don’t do properly. There’s also big issues out there, too, and aestheticians, and I know this because I just did a presentation with a group of girls just this last week at an aesthetic school in Ontario, and one of their questions was just what you’re asking me here from the awareness perspective.

[00:13:36] Morag: What can we do to help prevent and stuff like that? So we talked about it, but one of the other things that I also addressed based on the Sun Protection 60 in the past two aspects to it. They asked which ingredients are best, is a chemical sunscreen good or a physical? And of course, I am a great strong advocate for the physical with your zinc dioxide and your tain- titanium dioxide.

[00:13:59] Morag: The [00:14:00] chemical sun protective ingredients are most of the time absorbed into the system, whereas your titanium and zinc is sitting on the surface of the skin. So that’s a big difference, and so that’s one aspect of it. The other thing, and I learned this from Dr. Des Fernandes, and he is a plastic surgeon or cosmetic surgeon in Cape Town in South Africa, and he started f- hi- from his surgery practice, he was working mostly with skin cancer, and that’s why he landed up promoting a skincare line that is very strong on vitamin A is just to help prevent skin cancers and stuff like that.

[00:14:39] Morag: But what he said to me was, “Morag, remember we need UV for vitamin D conversion, vitamin D3 conversion.” So we need 10 to 20 minutes of full body exposure to UV on a daily basis.

[00:14:57] S4OM/S4OE: Okay

[00:14:58] Morag: And so it’ll [00:15:00] depend. The more pigment you have in your skin, you don’t need the 20 minutes. You can get away with 10. But somebody who’s a much older person, remember, is going to need more.

[00:15:10] Morag: Some people also with a lighter skin do- I mean, and you’re going out at the early morning or the late afternoon or something like that. But get as much sun on your, as much of your body that you can every day for vitamin D conversion. And so all of a sudden, everybody was missing the whole vitamin D thing, and the vitamin D def- deficiencies start to arise now

[00:15:34] S4OM/S4OE: Wow. So we think we’re solving one problem, and we’re creating another problem.

[00:15:39] Morag: Yes

[00:15:40] Morag: Yes

[00:15:41] S4OM/S4OE: And I think that, that whole sun exposure vitamin D conversion, like those conversations just get left out when people are so focused on skin cancer. It’s yes, be aware, but the sun does do things that our bodies need,

[00:15:57] S4OM/S4OE: right? Yes

[00:15:58] S4OM/S4OE: Um, and that will [00:16:00] allow us to be as healthy as possible within reason, right? Yes.

[00:16:06] Moles and Melanoma Risk Factors

[00:16:06] S4OM/S4OE: So let’s talk about moles, because that feels like this kind of weird gray area. Everyone’s “It’s just a mole. It’s just a mole. It’s just a mole.” but are the number of moles an indicator of risk of skin cancer for people?

[00:16:23] Morag: Yes. Yes. There is something out there called the FAMMM syndrome. Familial atypical multiple mole melanoma syndrome. It’s a

[00:16:34] Morag: long name. So it’s F-A-M-M-M. And this is typically a much lighter toned skin, like a Fitzpatrick one, if you’re into the Fitzpatrick scale there. Somebody that really has that redhead gene and very pale translucent skin.

[00:16:52] Morag: So the FAMMM syndrome is more common with these people. So it looks like a person with multiple freckles and moles, [00:17:00] and they are three times higher for a risk for melanoma. You’ve got people with multiple moles on their body, and moles if you look at the A-B-C-D-E-F they should be pretty spherical.

[00:17:13] Morag: They should be uniform in color. They should be a nice sort of rounded appearance. The border should be clearly defined. And so when you start to look at that’s what a typical mole is. But when you have five moles that are like the tip of your eraser on a pencil, that’s about six millimeters.

[00:17:34] Morag: If you have more than five moles like that on the body, you have a three times risk, higher risk for sk- for melanoma as well. A person that’s also immune suppressed has a three times higher risk of melanoma. So there are these indicators that aestheticians can have, and they can ask these questions when they’ve got clients coming into the spa.

[00:17:57] Morag: “Do you have lots of freckles and moles on the [00:18:00] body? Have you ever had the moles counted? Do you know how many moles you’ve got on your body? Have you had any moles changing?” and so yeah, there’s just so many indicators that a person is at much higher risk for melanoma in particular, but also skin cancers.

[00:18:16] Morag: If somebody’s had your basal cell and squamous cell carcinoma or melanoma in the past, that increases their risk as well for getting another skin cancer in the future.

[00:18:27] S4OM/S4OE: Yeah

[00:18:27] Melanoma Drugs and Pigment Loss

[00:18:27] Morag: A side note to that, and I know that I’m not trying to redirect the conversation here, but it also pertains to cancer survivors right now being treated for melanoma.

[00:18:40] Morag: There are some drugs on the market at the moment which fall into their, I believe, their immunotherapy drugs or targeted therapy drugs or a crossover into those two categories there. I’m just trying to remember their names now Your boy is one. Anyway, [00:19:00] it’s being prescribed a lot for people with melanoma at the moment, and these drugs are causing a vitiligo type rash on people.

[00:19:09] Morag: So now think about this. We’ve got melanin in our melanocytes, and they’re there for protective purposes. So now all of a sudden these people have had a melanoma removed, and they’ve been given drugs the melanoma, in other words, to kill off that melanoma, and causing the skin to lose all the pigment.

[00:19:32] Morag: And so people are coming up with that and it is, they call it a vitiligo type rash. So now I’ve been following a group that have been talking about it because they’re post- people are posting up on social media and stuff what their skin looks like with this rash. And then I’ll say to them “What does your oncologist have to say about this?”

[00:19:52] Morag: “No, the oncologist is happy because they said the drug’s working.” And I said, “Okay, but I’m coming…” And I don’t go in from [00:20:00] an aesthetician or I don’t come in with an an attitude to say, “Well, the oncologist is not doing you a favor.” I’m not doing that at all. I’m just saying to them, “Just pay attention to your skin, because what’s happening here is the melanin in your skin is being destroyed from these drugs.

[00:20:18] Morag: Your melanin is there to protect the skin. And so now all of a sudden you’ve got this white skin.” Where I’m talking there’s no pigment left, there’s no pigment there. “You’re going to be at risk for future skin cancers, and you’re gonna be at risk for burning.”

[00:20:36] Morag: And then they look at, they look at me like, “Well, w- we go with what our oncologist says.”

[00:20:41] Morag: And I’m like, “Okay. You know what? That’s your choice.”

[00:20:45] Morag: But that is the reality of what melanin does. We need melanin in our skins.

[00:20:52] S4OM/S4OE: Right. Right

[00:20:54] Morag: I can’t force people to put sun protection on. And I mean, the other side effect of that drug, obviously it, [00:21:00] it impacts a person’s appearance

[00:21:02] Morag: because if you recall Michael Jackson, how w- him having a beautiful coffee colored skin and then all of a sudden he got this white vitiligo.

[00:21:10] Morag: And so when somebody’s, it doesn’t matter what color you are, but if you start to lose the pigment in your skin and you’ve got this mottled rash all over your body, very hard to cover up

[00:21:21] S4OM/S4OE: Right. Right. And obviously you’ve already kind of survived melanoma, and now the treatment is making you at risk for more cancer or more

[00:21:34] S4OM/S4OE: skin cancer later on. And that’s… And of course people aren’t actually thinking about it, right? They’re just, they’re being given these drugs and trusting that their oncologists are sending them in the right direction.

[00:21:47] S4OM/S4OE: But there’s always something a little bit more complicated.

[00:21:51] Morag: Yeah. Look, you know what? With all due respect to oncologists, they’re doing their job. They’re focusing on killing the cancer, okay, or the

[00:21:59] Morag: [00:22:00] cancer cells. Secondary to cancer is dealing with skin related issues. Ultimately, if the person ends up with a skin cancer in the future, I guess the oncologist will come in again and deal with that specific skin cancer.

[00:22:13] Morag: So they see things very differently to the way we do as aestheticians. We’re saying, “Protect your skin while you’re going through treatment,” because you don’t want to have another skin cancer. I

[00:22:25] Morag: mean, you don’t wanna have a deformity because you’re gonna have to have, your nose chopped off or your ear, and then you have to have a prosthesis and all this kind of stuff.

[00:22:33] Morag: Or you have a deformity, and then all of a sudden psychologically you’re going to be impacted because you don’t want people to look at you

[00:22:39] Immunosuppression and UV Reality

[00:22:39] S4OM/S4OE: You mentioned something that I just wanted to ask a question about. So when people are immune compromised or ha- immune suppressed, whether it’s due to chemotherapy or radiation or some other kind of autoimmune disease, are they more at risk for skin cancer?

[00:22:55] Morag: Yes.

[00:22:56] S4OM/S4OE: Okay.

[00:22:58] S4OM/S4OE: Okay. So that is also [00:23:00] something that estheticians should be asking about in

[00:23:03] S4OM/S4OE: terms of medical history.

[00:23:05] Morag: Absolutely. Yes years ago I also had a kidney transplant survivor when I was living in Arizona, and she was lucky. She never, ever developed melanoma in the time I knew her, but the squamous cell and basal cell carcinomas. Now, I can’t remember if she just had one kidney transplant or if one of them may have failed and she had to have a second one, but irrespective of that, she landed up being on prednisone for at least 10 years afterwards.

[00:23:39] Morag: So she landed up having the skin that was impacted by prednisone, which was obviously quite thin used to tear very easily burnt in the sun, and it almost got to the point where she could tell her dermatologist… She saw a derm every three months because she would I’ve got a squamous cell ca- carcinoma coming up.”

[00:23:59] Morag: “No [00:24:00] we’ll check it in another three month.” “I want it biopsied.” “Oh, okay. Let’s biopsy it. Oh, by the way, yes, that was a squamous cell carcinoma.” so when you’re immunosuppressed and the UV damage, and again, we’re talking about and somebody said this to me the other day “Oh, well, we don’t need to put sun protection on ’cause it’s cloudy out there.”

[00:24:20] Morag: I’m like, “Oh, you need sun protection.” Doesn’t make a diff- oh, I know. It was, yes, some people went out fishing, and they came back, and they were all burnt, and I said, “You should have been wearing sun protection or have a hat on or something like it.” “No, it was cloudy out there.” I’m like, “Here we go.” And this is what I’m saying, is you have to constantly remind people about it.

[00:24:43] Morag: They don’t take it seriously

[00:24:46] S4OM/S4OE: Right.

[00:24:47] Hidden UV Sources

[00:24:47] S4OM/S4OE: Sun exposure is obvious, but what are, like, less obvious sources of UV radiation that people are not connecting to skin cancer risk?

[00:24:57] Morag: one of the biggest ones that [00:25:00] is in our industry, and I don’t know if they’ve changed the UV lights with artificial nails People that were having gel and acrylic, I think mostly gel nails, they would be putting their fingernails in there, and then people started getting melanomas in the fingers, fingernails

[00:25:22] S4OM/S4OE: Wow.

[00:25:23] Morag: People don’t think about these things. Yeah

[00:25:26] S4OM/S4OE: so did they change that in

[00:25:28] S4OM/S4OE: the nail

[00:25:29] Morag: I haven’t looked into it for a while, but it’s something I can look into. But it is UV light, but what is the wavelength that they’re actually using in there? So when it comes to aestheticians, even working with light therapy know your wavelengths and know specifically where there’s protection.

[00:25:49] Morag: The other one is tanning beds. People the people that I’ve met that go to tanning beds actually have an addiction to this, so there’s a, an en- a endorphin buildup [00:26:00] when they go into the tanning bed. Psychologically, they br- I mean, they’re browner physically, but psychologically, they’re happier, and they’ve got more energy and stuff like that, and they don’t realize the damage that they’re actually doing to their skin.

[00:26:15] Morag: And tanning beds UVA in particular is in the tanning beds like the UVB, and the UVA is the one that’s causing all the issues. Now, the other one, which is, of course, UV-related is of course people like flight attendants and pilots, and I know you’re gonna interview Scott and he will tell you exactly what their exposure is because even those windows in the aircraft have no protection, and these guys are exposed to UV radiation.

[00:26:43] Morag: So yeah people apparently there is a much bigger awareness about this now, but I’ve been talking about flight attendants and pilots for quite a few years now because I’ve heard more and more of them getting skin cancers and stuff like that[00:27:00]

[00:27:00] S4OM/S4OE: Wow.

[00:27:00] Lifestyle Risk Patterns

[00:27:00] S4OM/S4OE: So aestheticians, to be as comprehensive and as well-informed as possible, should know a lot about their clients, right? Not just their medical history or their skin cancer history, but even what they do for a living or how they live their life, if they get gel manicures or if they go to tanning beds.

[00:27:22] S4OM/S4OE: Wow

[00:27:22] Morag: Yeah. Lifestyle. You’ve gotta go into the lifestyle, and don’t just talk about today. You’ve gotta get into the history of the lifestyle. How much sun exposure have you had over the years?

[00:27:33] Morag: Sort of what climate are you living in? For example, let’s look at the UK. The UK is drizzly and raining in winter, but what do the British people do partic- they go over to Spain.

[00:27:45] Morag: “Oops, let’s go and lie on the beach, and let’s get burnt,” okay? So sometimes you’ll get those seasonal burns, which is more prevalent with basal cell carcinoma and melanoma. Then you get people, let’s use [00:28:00] Arizona, for example, people that live and work in the desert, people doing construction work, road work, farmers, all that kind of stuff.

[00:28:07] Morag: They’re exposed to sun all year round, more prone to squamous cell carcinomas. So lifestyle really matters. Protecting the skin, the medications a person takes how immune suppressed they are. Yeah, it’s just, there’s a lot of questions that aestheticians can ask.

[00:28:24] Mole Mapping Referrals

[00:28:29] Morag: But I keep saying they need to do year-round marketing on this, put signs up in your washrooms and just say, “When last did you have a mole check?” Or, “When last did you have your body checked for sunspots?” If you wanna make it user-friendly, just say, “When last did you have that done?” And I am encouraging aestheticians to do mole counting and measuring. We’re not diagnosing.

[00:28:49] Morag: We’re not saying anything like that. All we’re doing is counting and measuring because some people don’t even know how many moles they have on their body. Because of the added risk, fill it [00:29:00] out on a form, tell them to take that form and go and see their GP. Highlight any if you … I have an an outline.

[00:29:07] Morag: I do have a little plastic ruler that I have with different millimeter measurements on it, but I have an intake form which you fill out which has got a body outline. So if you see anything unusual, circle it. Give them a copy of it. Tell them to take it to their GP. And if anything, take their phone, take photographs of it every time, or you take pictures.

[00:29:29] Morag: Send them the pictures so that the doctor can see the changes because GPs are not trained in skin cancer. So a lot of them, if it doesn’t look iffy to them, “Oh, you know what? Watch and wait. We’ll just see you in six months and see if anything’s changed.” Well, if it’s an aggressive cancer like melanoma, six months can be too late.

[00:29:51] Morag: You

[00:29:51] Morag: can’t play with it. You can’t play with aggressive cancers, and melanoma is aggressive. Melanoma can metastasize very quickly. Your s- and that’s [00:30:00] why the treatment for melanoma is quite aggressive as well. Now, squamous cell carcinoma can also metastasize. Your basal cell carcinoma doesn’t really have

[00:30:10] Morag: It can, but it’s slow-growing, and it the potential to metastasize is not as great as your squamous cell. But the greatest one is your melanoma

[00:30:20] S4OM/S4OE: And I kn- I know several people where we were dealing with metastatic melanoma and it was horrible. Really horrible.

[00:30:28]

[00:30:29] Darker Skin Detection

[00:30:29] S4OM/S4OE: I wanna go back to something that you said that obviously is very significant for me, um, as a person with a darker skin tone. That there’s, A, a lot of misinformation for people with darker skin about their skin cancer risk. Um, where do you see that aesthetics can support people with darker skin, about protection and detection?

[00:30:56] Morag: I’d say it’s the same for all skin types. I would just [00:31:00] tell people in general, but when you’ve got a bigger market with people with the darker skin tone, you really need to do a lot of education for everyone that comes in. And for example, when I say that, I particularly like to say, “Just because you have a darker skin, do you really not need to be checked?”

[00:31:17] Morag: Or something like that. So it becomes a conversation. I’m always looking for ways to start a conversation with somebody irrespective of their color. But if you really are focusing on darker skin, like if I was in, I’m gonna pick Maryland, for example, because I have one of my trainers who lives in Maryland, and she is from Africa.

[00:31:38] Morag: And when we talk about people with darker skin her client base is primarily African Americans coming into her spa. And so she, like we, we’ve discussed, we have to have marketing information for them that particularly says, “Just because you have a darker skin, just because you’ve got more melanin in your skin, doesn’t absolve you from [00:32:00] getting the, your skin cancers.”

[00:32:01] Morag: And on the other hand, what we have to educate this the aestheticians with lighter skins that only have a client base that’s primarily lighter skin. When you’re working with somebody with more pigment in their skin, it is harder sometimes to detect because your skin cancers, particularly the melanomas with pigment in, because you can get melanomas too with no pigment, but if you get them with pigment in, sometimes it blends in with the normal skin tone, so you’re not actually picking up if there’s an anomaly or some- there or not.

[00:32:35] Morag: I mean, it’s the same thing, but I don’t differentiate between whether you have a much, much darker skin to a light skin. I say across the board everybody needs to have sun protection. However, those with the darker skin are gonna have more protection. But why should they only apply a sunscreen once a day, and somebody with the lighter skin needs to reapply it every one and a half hours?

[00:32:57] Morag: No, apply the same principle right across [00:33:00] the board there. I would… And I’d say that there does need to be more training for aestheticians to actually learn to recognize any lesions on skins with more pigment in them. So even just looking at a sebaceous hyperplasia, and skin tags, and stuff like that.

[00:33:18] Morag: There are differences in color, and that comes with experience as well. And also asking questions. And I think aestheticians, without being invasive you know what? I love the approach and I always just say to somebody, “I’ve never really seen that before. Could you tell me more about it?” And I actually put the client in the position of being my educator.

[00:33:37] Morag: If they can give me any, like if they perhaps have had a skin cancer or they don’t know what it is I would encourage them to go and see a dermatologist and, “Oh, by the way, please come back and tell-” tell me what the diagnosis was and give me the medical term. Don’t come back and tell me it was a skin cancer.

[00:33:55] Morag: That doesn’t help me at all.

[00:33:57] Morag: So many people do that. “Oh, I just had a [00:34:00] skin cancer removed.” Okay, what kind of skin cancer? Because that makes a huge difference. If you’ve had and of course, if you’ve had a history of cancer, there’s likely that’s going to, your person’s going to get skin cancers in the future, so something that an aesthetician should be looking out for as well.

[00:34:16] Morag: I know my clients had melanoma in the past. I know my clients had basal cell and squamous cell carcinomas in the past. Oh, and I’m seeing something strange here.

[00:34:25] Treating Precancer Spots

[00:34:31] Morag: And sometimes even the beginning stages of your squamous cell carcinoma are just scaly bits of skin don’t just ignore that if that little bit of scaly skin continues to be there.

[00:34:36] Morag: Now actinic keratosis can, is also a little bit fluctuating. In the summer months it seems to say, “Hello, I’m here.” In the winter months it kinda subsides a bit. So people then are in this false belief, “Oh, it’s disappeared. It’s not there anymore.” And then summer months come, and then they got this little bit of scaliness there.

[00:34:54] Morag: And that’s an easy thing to sort out. I mean, you know what? If the esthetician’s working in a [00:35:00] medical spa or whatever, it’s cryotherapy. Cryotherapy is going to actually remove that bit of scaliness. Sometimes topical chemotherapy even if you don’t have any known s- basal cell, squamous cell carcinoma and that sometimes you can get a topical chemotherapy from your dermatologist, and it burns all those cancer cells away.

[00:35:21] Morag: I’m telling you, you look raw and red. You can’t have facials. You can’t put cream on your skin. You’re probably just putting Vaseline for a period of time. But you know what? You’re getting rid of it before it develops into something where you’ll end up having deformities and you have to have treatment for and all this kind of stuff.

[00:35:37] Morag: So prevention is really important

[00:35:40] S4OM/S4OE: Okay.

[00:35:41] Oncology Skincare Basics

[00:35:43] S4OM/S4OE: So for aestheticians who work with people who are in treatment, they’ve had chemotherapy, radiation, immunotherapy even obviously probably across those three different treatments people present differently. But what do aestheticians need to know [00:36:00] and understand about compromised skin and then skin cancer risk in the oncology population?

[00:36:08] Morag: Well, since I since I started training, I’ve always said when somebody is going through active treatment there’s, you, there’s a c- couple of different things. If a person has radiation and surgery to a localized area, where is the localized area? Because you can protect the localized area with any creams and stuff like that you need.

[00:36:30] Morag: But if the person is on systemic treatment, like your drug therapies that person is going to be so much more prone to having a sensitive skin, an irritated skin, a skin that can burn. Maybe they might be photosensitive because of UV radiation and stuff like that. So what I’ve always taught is when somebody goes through active treatment, particularly your drug treatments, you’re going to wash the skin.

[00:36:56] Morag: You do need to have a cleanser because you want [00:37:00] environmental dirt, you want makeup, you want any sort of drug that could be excreted through the skin. Anything that needs to be removed from the skin, take it off. Wash your face twice a day, but don’t… And really, cleansers only stay on the skin for a minute, if that.

[00:37:15] Morag: So even if somebody likes to use a gel wash that might even have a sulfate in, which I don’t encourage, because sulfate is a dishwash liquid it di- dissolves fat. You wanna keep as much fat or lipids in the skin as possible. But anyway, a cream cleanser. Remove all the stuff you don’t need on your skin.

[00:37:34] Morag: Then hydrate it, and then protect it. Use your sun protection So absolutely necessary. And the regime is very simple. During active treatment, sometimes a person might be very overwhelmed with, “Oh, well I’ve got to remember all my drugs, and I’ve got to remember my appointments, and you’re asking me to do seven steps of my skincare twice a day.

[00:37:57] Morag: Not gonna happen.” Overwhelmed, [00:38:00] tired, all this kind of stuff. Keep it so simple during active treatment. Once a person’s finished with active treatment, you can start to rebuild their skin slowly.

[00:38:12] S4OM/S4OE: Mm-hmm.

[00:38:12] Morag: Test it. Do patch tests. If you’re gonna use things like peptides and niacinamide and anything to help rejuvenate, restore and rebuild the skin, just do it slowly.

[00:38:24] Morag: Don’t suddenly, “Oh, well now I’ve got to like…” Give her seven steps to do she’s in recovery. Just do it slowly, because the skin has taken a big beating, particularly with chemo. What we’re also seeing now with some of the newer drugs, your biological therapy group, which is your immunotherapies and targeted therapies and vaccines and stuff like that, the skin is being impacted.

[00:38:44] Morag: Not as badly as with chemotherapy, but still there’s a lot of photosensitivity and these a lot of these drugs haven’t been out for that long. So we’re starting to see some of the long-term side effects from some of the newer drugs as well. But just, be kind to the [00:39:00] skin. I mean, at one point in my career, it was like you’ve got to just beat the skin up with chemical peels and microneedling, all this.

[00:39:08] Morag: Create a wound, because it forces new cells to be regenerated. Well, yes, but your body can only take so much of that. There’s a certain limit that your body can take before it’s kind of going to, “Oh, yeah, I’m running out of steam here.” So I’m saying when somebody is so compromised, their skin, their nails, their hair, even mentally, like cognitively, it’s just just don’t beat your skin up.

[00:39:30] Morag: Don’t beat your mind up. Just take it easy, but protect it. Protecting is really important.

[00:39:37] S4OM/S4OE: Good messaging. Good messaging.

[00:39:39] Paying For Expertise

[00:39:39] S4OM/S4OE: Before we sign off, let’s talk a little bit about the profession and the advocacy that you do. Clearly you want oncology aestheticians to be compensated for the clinical level of their service. How does skin cancer awareness fit into that argument?[00:40:00]

[00:40:01] Morag: Oh, that’s a two-pronged question. I don’t, I think the world of oncology, the cancer world, for some reason cancer support groups all this kind of thing seem to think that spa treatments need to be free for cancer survivors, and I don’t agree with that. Look, I know cancer can destroy people’s livelihoods.

[00:40:24] Morag: There are a lot of cancer survivors that don’t have health insurance, and of course, they don’t have money to pay for their treatment, therefore they don’t have money to pay for spa services and stuff like that. But the medical fraternity haven’t taken us very seriously, and this is why I guess they think we can do free services.

[00:40:45] Morag: Okay, it’s just foo-foo pretty stuff. But we need to change our language. We need to ch- we need to start saying, “You know what? We can be part of the circle of care.” We need to up our ante as far as how we’re promoting ourselves [00:41:00] and stuff like that. We need to have some self-worth and say, “I am worth that.”

[00:41:04] Morag: I also argue with students in my class. Well, I’m not argue, I just suggest to them, “If you’re going to give free treatments to people that are going through cancer treatment, why are you not giving free treatments to people going through lupus and rheumatoid arthritis? Because they’re also going through chemotherapy.

[00:41:19] Morag: Why are you not giving free treatments to people with diabetes?” So just, think about the aspect of just giving away free things. There are times and places for that.

[00:41:32] S4OM/S4OE: Right

[00:41:32] Morag: You can do events and you can also do a community thing where you can put the word out to your existing clients and say, if you know somebody who really can’t afford it that could really benefit from…

[00:41:44] Morag: I have a quiet day on a Monday afternoon, I’m willing to do once- one treatment a month for somebody that really can’t do it.” But to sit there… And look, some aestheticians are very empathetic and some are like, “Oh, I can’t be charging them.” Also, put yourself in the cancer [00:42:00] survivor’s shoe. Sometimes a cancer survivor has the money, and then they don’t want you to sympathize and say, “Oh, shame.

[00:42:06] Morag: Just because you’re going through cancer, I’m not going to charge you.” “No, I came here expecting to pay.” So there are a couple of different ways to actually look at that. But aestheticians not need to start upping the ante as far as the language goes, upping their education, and this is where the Society for Oncology Massage and onco- the Society for Oncology Aesthetics if we’re providing more content for them, if we can push for them to get continuing education every year that’s gonna be a battle with the state boards.

[00:42:39] Morag: But you know what? Those aestheticians that see their value will pay for education and will go and find those cancer survivors to actually work with and get the experience. And this puts them in a whole different realm to somebody who might have just finished school and says, “You know what? I’m just gonna do eyelashes.”

[00:42:59] Morag: Okay. [00:43:00] So aestheticians is a broad term. So somebody that just does eyelashes and somebody that really wants to help take care of people with health whether it’s a physical or mental health challenge, it puts you in a whole different ballgame altogether

[00:43:15] S4OM/S4OE: Yeah. Yes, it does. So, thinking about the spa directors and the folks who own these businesses who’ve never thought about skin cancer as part of their professional responsibility, what’s the one thing you want them to leave this episode knowing?

[00:43:38] Morag: They’re doing a disservice to their clients. They, you know what? Our focus as aestheticians is skin We need, every aesthetician out there, whether you’re employed or whether you’re a spa director, you need to know what the skin is about. Somebody the other day said to me she did this beautiful little slogan [00:44:00] about people come to the spa with healthy skins but then when people go through cancer treatment, th- this, th- their skin is impacted with all the treatment for cancer.

[00:44:08] Morag: And whilst I love the little slogan, I don’t know how it was written, but I actually said to her, “I disagree with that statement actually, because what is a healthy skin?” A baby typically is born with a healthy skin. So define what a healthy skin is. It’s soft, it’s moist, it’s free from all imperfections.

[00:44:30] Morag: But with life, as we get older, with, our exposure to all sorts of things our diet, lifestyle, everything impacts the skin. So people come to the spa because they’ve got acne, they’ve got pigmentation, they’ve got rosacea, they’ve got aging skin. That’s not a healthy skin. However, they are, when you consider them to somebody who has had a diagnosis of cancer, they are considered healthy.

[00:44:57] Morag: And so a lot of aestheticians actually [00:45:00] are greatly misinformed where they say, “We don’t work with sick people.” Oh, well, you don’t work with sick people? What about these people with these unhealthy skin conditions that you’re working with? They may be healthy on the outside, their appearance may be healthy.

[00:45:17] Morag: You don’t know what’s going on inside of them. But somebody with a cancer diagnosis comes in, and that’s why sometimes cancer survivors don’t wanna talk about it. they just want to be pampered, if you wanna look at it, relaxation and stuff. They don’t wanna talk about it. But it’s a disease. It doesn’t mean they’re unhealthy.

[00:45:36] Morag: They’ve just developed this disease, and the disease is being treated there. So it’s just a play on words. When somebody says, “I have a healthy skin,” like aesthetician saying to me, “We don’t work on sick people.” Well, okay. Then I think you’re in the wrong business too, because you don’t know who is coming into your spa to be a potential client.

[00:45:57] Morag: You don’t know who might be an existing [00:46:00] client who might land up getting a cancer diagnosis. This is not the business for you if you can’t handle a sick client.

[00:46:07] S4OM/S4OE: Mm-hmm. I always say people don’t make decisions about where to get services like massage or aesthetic services based on their health history. They go where we are. So they seek out the service. You’re the provider. That comes with a whole level of responsibility and understanding so that you can keep them as safe as possible and support them however they show up

[00:46:34] Morag: Yeah. Erica, it comes back to the same thing as like we really should have different… I know there’s a master esthetician, and then there’s b- they have some little levels there. But there are estheticians out there, some of them that put themselves through so much training, they get so much experience, they’ve got so much knowledge.

[00:46:53] Morag: But you see, this is where they’re lumped into the same category as somebody who might be just doing eyelashes. [00:47:00]

[00:47:00] S4OM/S4OE: Mm-hmm.

[00:47:01] Morag: it’s not a very balanced field and we need to have more recognition for those that have spent all this extra time and money in getting educated and stuff like that because there’s a real lack in, particularly here in North America.

[00:47:16] Prevention System Gaps

[00:47:16] Morag: Australia’s full of skin check clinics or skin spot clinics. Y- you can go to… On every street corner, there’s a little I don’t know if they call it a salon or a spa or a business, or a medical practice, but you can get a skin check. Because with the sun there and skin cancer being so prevalent.

[00:47:37] Morag: But why are we not having them here? Because even in the United States alone, you’ve got Arizona, Nevada, California, all those states where you’ve got sun year-round and people getting burnt, and, your risk of cancer is much higher in those areas. Or if you’ve got people from Michigan or from Illinois hitting the sun i- in the summer months and just [00:48:00] getting burnt.

[00:48:01] Morag: We need to have more skin checks. And in Australia, a skin check is almost a 50-minute treatment, like full body. Whereas here, I know in Canada, if you see the GP for a check, you might be there for 10 minutes.

[00:48:18] S4OM/S4OE: Right

[00:48:19] Morag: And how much, how thorough is a 10-minute assessment versus a 50-minute assessment? So I think we still have a long way to go here in North America with regards to skin cancer awareness, skin cancer prevention.

[00:48:34] Morag: I think there’s a lot that can be done here. And, what surprises me is that people in general, plus companies and stuff like that, plus medical insurance companies, why not just keep pushing for prevention and awareness? Because ultimately it’s, like how much does it cost to treat skin cancers?

[00:48:57] Morag: What does it cost the actual client that’s [00:49:00] diagnosed? What does it cost the h- insurance company? What did it cost the hospitals? So think about all the money that could be saved if people were, like, really pushed on preventing skin cancers and stuff. Look, it is being done. I mean, here in Canada it gets done, but it’s not strong at all.

[00:49:18] Morag: It’s not powerful. It’s not driven. It’s not about… And sometimes you might have to shock people. You might have to say, “You know what? This is what happens,” or, “This is what it looks like when you’ve just had half your jawline cut out, and this is the deformity you’re dealing with. Now, this is what it’s going to cost to do this reconstructive surgery.

[00:49:37] Morag: Who’s covering it?” The person doesn’t have medical insurance, she can’t pay for it. He or she can’t pay for it. And yeah, so then this person sits with the deformity, and then all sorts of other things start to exacerbate at that point

[00:49:50] S4OM/S4OE: Yeah, we need to do more. We need to stop ignoring the fact that skin cancer is something serious.

[00:49:56] S4OM/S4OE: Um, I have clients with skin cancer, and it’s amazing [00:50:00] to me how they don’t consider themselves to be cancer clients. They’re like, “Oh, I just have skin cancer.” And I’m like, “You just said it. You have skin cancer.

[00:50:11] S4OM/S4OE: That’s not a small thing.” but again, how seriously do we take it?

[00:50:17] Education And Wrap Up

[00:50:17] S4OM/S4OE: All right, last question. For an esthetician who’s just starting out, what’s the single most important thing they can do to be better prepared to serve clients who may be navigating skin cancer?

[00:50:31] Morag: I would say get educated. I honestly would say that because I can’t see how an esthetician, whether you’re a new student or whether you’re somebody been in practice for a while, if you don’t know benign lesions and you don- you, you don’t know different changes in the skin like that and how the skin actually operates even, I mean, there’s different levels of damage done to different layers of the skin with your different skin cancers too.

[00:50:58] Morag: Do people, do [00:51:00] estheticians even know that there’s a mutation in the actual melanocyte for it to trigger off melanoma? Do estheticians know that there’s a mutation in your, um- what’s the, The second and third layer of the skin up now.

[00:51:15] Morag: I’m having a brain freeze moment, but anyway, they’re squamous cells, so you’ve got your five layers of the skin, and so your melanocytes and your basal cells are in the very bottom layer of your skin, and that’s where you’ve got your basal cell and your melanoma being triggered off from mutations there.

[00:51:31] Morag: And then, oh, the granulosum layer is one of them, the sa- the third one up, I think. But anyway, that’s where your squamous cell carcinoma might get a mutation and trigger off squamous cell carcinoma. So know the skin, know the lesions on the skin the benign ones and potential cancerous ones even though we can’t diagnose.

[00:51:50] Morag: Know know what questions to ask the client because if you don’t have a history on them… And know how to talk to them

[00:51:57] S4OM/S4OE: Most importantly, communication[00:52:00]

[00:52:00] Morag: Yeah,

[00:52:01] Morag: absolutely. Absolutely

[00:52:03] S4OM/S4OE: Wonderful. Thank you. Thank you so much. This has been tremendously informative. I have learned so much, and we really appreciate you taking the time to educate our listeners today

[00:52:16] Morag: Oh, you’re very welcome. I’m sure you did learn something new. I learn something new every time I’m chatting to somebody, so it’s exciting. That’s yeah. So thank you very much again for the interview

[00:52:27] S4OM/S4OE: Wonderful. Wonderful. Have a great day, collaborators, and I hope you enjoy today’s podcast

[00:52:34]