Case 57

You were asked to consult on a 15-year-old obese Chinese male who was being treated for osteogenic sarcoma. During his back examination, you noticed several pattern marks which covered his back from his cervical to his lumbosacral paraspinal areas (Image 57a). Some were circular and others appeared to blend together and coalesce around the spine. They were red and purple in colour. The lesions are slightly tender to the touch, but there is no break in the skin. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig57a.jpg"/>

What are the possible causes for these findings?

Do you have any recommendations about further treatment?

132 https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig57b.jpg"/>

The circular lesions suggest an object with a curved or curvilinear edge has been applied to the skin to cause bruises. Given that there is some bruising in the centre, additional pressure or force has been used within the outlined objects. The location of the lesion away from bony prominences suggest non-accidental trauma. This pattern is consistent with a complementary medical practice called cupping. ¹ Cupping therapy is an ancient Chinese form of alternative medicine in which a local suction is created on the skin; practitioners believe this mobilizes blood flow in order to promote healing. Suction is created using heat or mechanical devices and is known in local languages as baguan, banki, bahnkes, bekam, buhang, bentusa, kyukaku and ciogio, among other names. The patient and his family confirmed that he had been treated with the practice 4 days before. The lesions appeared more extensive on day 1 (Image 57b).

It is important to realize that families use a variety of traditional and non-traditional (complementary and alternative) treatments for cancer pain in their children. Depending on how it is applied, children often describe it as a soothing experience with little pain during the procedure and improvement in cancer pain for days or weeks afterward. In a review, psychoeducational interventions, music interventions, acupuncture plus drug therapy, Chinese herbal medicine plus cancer therapy, compound kushen injection, reflexology, lycopene, qigong, cupping, cannabis, Reiki, homeopathy and creative art therapies might have beneficial effects on cancer pain. ² Results were inconsistent for massage therapy, transcutaneous electric nerve stimulation and music plus cancer treatment. Given that these lesions are not preventable and may actually reflect the appropriate application of cupping, parents and children should receive appropriate counselling regarding reducing the pain of the procedure as well as complications from heat or bleeding, particularly if the child has coagulation problems related to their underlying diagnosis.