Despite the safety profile, the following special precautions should be considered when massage therapy is delivered to individuals with cancer:
- Avoid directly massaging any open wounds, hematomas, or areas with skin breakdown.
- Avoid directly massaging tumors that are apparent on the skin surface.
- Avoid massaging areas with acute deep venous thrombosis.
- Avoid directly massaging radiated soft tissue when the skin is sensitive.
Additional integrative modalities have been under investigation for their role in the treatment of secondary lymphedema. Selenium has been studied in clinical trial NCT00188604, and acupuncture and moxibustion are being studied in clinical trial LJMC-AMWELL-SL as treatments for lymphedema.
Refractory Lymphedema and Complications
If lymphedema is massive and refractory to treatment, or has an onset several years after the primary surgery without obvious trauma, a search for other etiologies should be undertaken. Of particular importance is exclusion of the recurrence of tumor or the development of lymphangiosarcoma, which should be excluded with computed tomography or magnetic resonance imaging. The complication of lymphangiosarcoma is classically seen in the postmastectomy lymphedematous arm (Stewart-Treves syndrome). The mean time between mastectomy and lymphangiosarcoma is 10.2 years, with a median survival of 1.3 years. Clinically, the lesions of lymphangiosarcoma may initially appear as blue-red or purple with a macular or papular shape in the skin. Multiple lesions are common; subcutaneous nodules may appear and should be carefully evaluated in the patient who has chronic lymphedema.
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