Melanoma is a serious form of skin cancer that develops from pigment-producing cells called melanocytes. While commonly associated with sun-exposed areas, this cancer can arise anywhere on the skin, including the scalp. The scalp often goes unnoticed during routine skin checks, making it a challenging location for early detection.
Identifying Potential Melanoma on the Scalp
Identifying potential melanoma on the scalp involves careful observation of any new or changing spots. The “ABCDE” rule provides a framework for assessing skin lesions: Asymmetry, Border irregularity, Color variations, Diameter larger than 6 millimeters, and Evolving, meaning changes in size, shape, or color over time. For the scalp, the “Evolving” characteristic is important, as a spot that begins to bleed, itch, form a crust, or a sore that does not heal, can signal concern.
Visualizing lesions through hair requires parting the hair to get a clear view of the skin beneath. Not all melanomas are dark brown or black. Amelanotic melanomas, which lack significant pigment, can appear as pink, red, or even skin-colored lesions. These non-pigmented forms can be mistaken for benign growths, scars, or common skin irritations, making their identification more challenging.
Why Scalp Melanomas Warrant Special Attention
Melanomas on the scalp warrant attention due to challenges in early detection. Lesions hidden by hair often lead to a delayed diagnosis, meaning the cancer may have progressed to a more advanced stage. This delay can result in the melanoma being thicker at diagnosis, which is associated with a higher risk of spreading.
The scalp’s unique anatomy also contributes to the risks of these melanomas. It possesses a rich network of blood and lymphatic vessels. This vascularity can facilitate the faster spread of cancer cells to distant parts of the body, a process known as metastasis, compared to melanomas on less vascularized skin areas.
The Process of Diagnosis
Regular self-examination of the scalp is a useful first step in identifying suspicious lesions. This can be done using mirrors to view all areas, parting the hair with a comb, or by enlisting the help of a partner, family member, or even a hairstylist to check hard-to-see spots. Any new or changing mole or lesion should prompt a visit to a healthcare professional.
When a suspicious spot is identified, a dermatologist will perform a thorough skin examination. They often use a dermatoscope, a specialized handheld magnifying tool that illuminates and magnifies the skin surface, allowing for a detailed assessment of the lesion’s structure and patterns. The definitive way to confirm a melanoma diagnosis is through a biopsy, which involves removing a small tissue sample from the suspicious area for microscopic examination by a pathologist.
Treatment for Scalp Melanoma
Once melanoma on the scalp has been confirmed through a biopsy, surgical excision is the primary treatment approach. This procedure involves removing the cancerous tissue along with a surrounding margin of healthy skin to ensure all cancer cells are eliminated. The width of this margin depends on the melanoma’s thickness and other characteristics.
Mohs micrographic surgery may be considered for certain scalp melanomas, especially those in cosmetically sensitive areas or with indistinct borders. This specialized technique involves removing thin layers of tissue one at a time, examining each layer immediately under a microscope until no cancer cells remain. For more advanced melanomas, additional treatments may be necessary, including a sentinel lymph node biopsy to check for cancer spread to nearby lymph nodes, or systemic therapies like immunotherapy or targeted therapy if the cancer has spread beyond the scalp.