Basal cell carcinoma (BCC) is the most frequently diagnosed form of skin cancer, originating from basal cells in the skin’s outermost layer. While it can develop anywhere, the scalp is a common location. This malignancy progresses slowly and, when detected early, is highly treatable.
What Basal Cell Carcinoma on the Scalp Is
Basal cell carcinoma arises from basal cells, found at the bottom of the epidermis. These cells produce new skin cells. When they undergo uncontrolled growth, a BCC forms.
The scalp is susceptible to BCC due to its direct exposure to UV radiation from the sun. Areas with thinning hair or baldness are especially vulnerable, as hair provides less natural protection against solar damage. While BCC rarely spreads, it can be locally destructive, potentially invading surrounding tissues like bone or cartilage if left unaddressed.
Identifying Basal Cell Carcinoma on the Scalp
Recognizing basal cell carcinoma on the scalp can be challenging because hair often obscures the lesions. One common presentation is a pearly or waxy bump, which may appear translucent and have tiny blood vessels visible on its surface. These bumps can sometimes resemble a pimple or an insect bite but do not resolve over time.
Another form of BCC on the scalp is a flat, flesh-colored or brown lesion that might resemble a scar. This type, known as superficial BCC, often has a slightly raised border and can be mistaken for a benign skin condition. Some BCCs manifest as persistent sores that may bleed, crust over, or ooze, failing to heal completely within a few weeks. A red, scaly patch that might itch or feel tender is also a possible sign, often mistaken for eczema or psoriasis.
Causes and Risk Factors
Chronic exposure to ultraviolet (UV) radiation from sunlight is the primary cause of basal cell carcinoma. Cumulative sun exposure over a lifetime, particularly during childhood, increases the risk. Individuals with fair skin, light hair, and blue or green eyes are more susceptible because their skin contains less melanin, offering reduced natural protection against UV damage.
A history of severe sunburns, especially blistering sunburns, increases the risk of developing BCC. Older age is another contributing factor, as the effects of sun exposure accumulate over decades. People with weakened immune systems, due to conditions like HIV/AIDS or immunosuppressive medications, also face a higher risk. Previous radiation therapy to the head or neck area can predispose individuals to BCC on the scalp. Genetic predisposition, indicated by a family history of skin cancer, also plays a role.
Diagnosis and Treatment Options
Diagnosing basal cell carcinoma on the scalp begins with a visual examination by a dermatologist. The doctor will inspect any suspicious lesions, noting their size, shape, color, and texture. If a lesion raises concern, a biopsy is performed to confirm the diagnosis.
A biopsy involves removing a small tissue sample for microscopic analysis by a pathologist. Common biopsy types include a shave biopsy, where a thin layer of the lesion is shaved off; a punch biopsy, which uses a circular tool to remove a deeper core of tissue; or an excisional biopsy, where the entire lesion and a small margin of surrounding skin are removed. The biopsy results determine the specific type of BCC and guide treatment decisions.
Treatment for BCC on the scalp varies depending on the tumor’s size, location, and specific type. Mohs micrographic surgery is a highly effective surgical option, particularly for tumors on the scalp, as it allows for precise removal of cancerous tissue while preserving healthy skin. During Mohs surgery, thin layers of tissue are removed and examined under a microscope until no cancer cells remain, minimizing the amount of tissue removed. Standard surgical excision involves cutting out the tumor along with a safety margin of healthy tissue, and the wound is then closed with stitches. Curettage and electrodesiccation is another surgical technique where the tumor is scraped away and the base is burned with an electric needle to destroy remaining cancer cells.
Non-surgical treatments are also available for certain BCCs, especially superficial or smaller lesions. Topical creams like 5-fluorouracil or imiquimod can be applied directly to the skin to destroy cancer cells. Photodynamic therapy involves applying a light-sensitizing drug to the lesion, which is then activated by a special light source to kill cancer cells. Radiation therapy uses high-energy rays to destroy cancer cells, often chosen for larger tumors or when surgery is not feasible. Cryosurgery involves freezing the tumor with liquid nitrogen to destroy the cancerous cells.
Prevention and Ongoing Care
Protecting the scalp from sun exposure is a main strategy for preventing BCC. Wearing wide-brimmed hats, ideally with a UPF (Ultraviolet Protection Factor) rating of 30 or higher, offers protection by shading the scalp, face, and neck. Applying sunscreen with an SPF of 30 or higher to exposed areas, especially those with thinning hair or baldness, is also advisable. Seeking shade during peak sun hours, typically between 10 a.m. and 4 p.m., reduces UV exposure.
Regular self-examinations of the scalp are important, though they can be challenging due to hair. Using a mirror or having a trusted individual assist can help in checking for new or changing moles, bumps, or patches. Professional skin checks by a dermatologist are recommended, especially for individuals with a history of skin cancer or multiple risk factors. Early detection through vigilant observation and professional screening allows for prompt intervention, leading to better outcomes.