Skin cancer, primarily Basal Cell Carcinoma (BCC), Squamous Cell Carcinoma (SCC), and melanoma, can develop on any part of the body, including the scalp. The scalp is constantly exposed to high levels of solar ultraviolet (UV) radiation, making it a common site for these malignancies. Approximately 13% of all skin cancers are found on the scalp, an area frequently overlooked during routine self-examinations. Hair coverage makes identifying lesions challenging, which can delay diagnosis and lead to more advanced cancer stages upon discovery. Understanding the specific visual signs of these cancers on the head is the first step toward early detection and improved outcomes.
Visual Signs of Skin Cancer on the Scalp
Basal Cell Carcinoma (BCC) is the most common form of skin cancer. On the scalp, it often presents as a small, waxy, or pearly bump that is flesh-colored or pink. These lesions may have fine, visible blood vessels on the surface, appearing shinier than the surrounding skin. A BCC may also manifest as a persistent, open sore that bleeds easily, crusts over, and repeatedly returns. Less commonly, it can look like a flat, scar-like, white or yellow patch with poorly defined borders.
Squamous Cell Carcinoma (SCC) is the second most common type and tends to appear as a firm, red nodule or a thick, scaly, crusty patch. These patches may feel rough to the touch and can sometimes be tender or painful. SCCs can also start as actinic keratoses—rough, precancerous spots—that progress into a defined, wart-like growth or a sore that does not heal. Because SCC often presents as a persistent, scaly area, it is sometimes mistakenly dismissed as severe dandruff or a simple irritation.
Melanoma is the least common but most serious type of skin cancer; lesions on the scalp are often more aggressive and diagnosed at a later stage. The ABCDE criteria apply to scalp melanomas:
- Asymmetry
- Border irregularity
- Color variation
- Diameter greater than 6 millimeters
- Evolving (changing)
Melanoma may appear as a new dark spot or an existing mole that changes shape, color, or height. The lesion might have multiple shades of black, brown, red, or blue, and its edges may be jagged or notched.
Why Detection on the Scalp Is Challenging
The presence of hair is the primary factor that makes detecting skin cancer on the scalp difficult, as thick hair physically obstructs a clear view of the skin’s surface. This obstruction allows small, evolving lesions to go unnoticed for an extended period, becoming more advanced before discovery. Individuals with male-pattern baldness or thinning hair have high cumulative sun exposure, increasing the risk of cancerous lesions. However, even those with a full head of hair are at risk because UV rays can still penetrate the skin, especially along the part line.
Self-examination is challenging because most of the scalp is impossible to view directly without assistance or specialized mirrors. People often focus on sun-exposed areas like the face and arms but neglect to systematically check the top and back of the head. When a lesion is felt or seen, it is frequently misinterpreted as a minor, non-cancerous issue, such as a bug bite, a pimple, or a patch of dandruff. This misinterpretation, coupled with the difficulty of visual inspection, contributes to the delayed diagnosis of scalp skin cancers.
When to See a Dermatologist
Any suspicious spot or symptom on the scalp should prompt a professional evaluation, especially if a lesion exhibits any of the ABCDE characteristics. Immediate consultation is warranted if a spot bleeds easily, is painful or tender, or does not heal completely within a few weeks. A sore that repeatedly scabs and reopens is a strong indicator that medical attention is necessary.
When you visit a dermatologist, they will take a thorough history and perform a full-body skin check, paying close attention to the scalp. They use a specialized handheld magnification tool called a dermatoscope to examine the lesion, which helps visualize features not visible to the naked eye. If the doctor remains concerned, the definitive diagnostic step is a skin biopsy, where a small tissue sample is removed and examined for cancer cells. Individuals with a history of skin cancer or significant sun exposure should prioritize annual or bi-annual full-body skin checks to ensure early detection.