Skin Cancer on the Scalp: Is It Melanoma?

Types and symptoms of skin cancer on the scalp

Skin cancer involves the abnormal growth of cells of the skin, and it usually occurs on areas that have more sun exposure. Skin cancer develops when errors occur in the genetic material (DNA) of skin cells. These mutations cause cells to grow abnormally, forming a tumor or mass of cells.

Skin cancer starts in the top layer of the skin (epidermis). The epidermis consists of three main kinds of cells: squamous cells, basal cells, and melanocytes. The type of cell where the skin cancer starts determines its kind and the treatment options.

Factors that can make you more prone to developing skin cancer on the scalp are:

• Having fair skin, light-colored eyes, and red or blonde hair and more easily developing a sunburn or freckles 
• A personal history of sunburns
• Excessive exposure to the sun, particularly if you don’t protect your skin with clothing or sunscreen
• Living in high-altitude or sunny climates
• Having abnormal or multiple moles
• Having precancerous skin lesions known as actinic keratoses 
• A family or personal history of skin cancer
• A weakened immune system such as from HIV/AIDS or immunosuppressant drugs after an organ transplant
• Having undergone radiation therapy for skin problems such as acne and eczema
• Exposure to certain substances such as arsenic

There are three main types of skin cancer: squamous cell cancer, basal cell cancer, and melanoma.

Melanoma on the scalp

Melanoma, also referred to as cutaneous melanoma and malignant melanoma, is a kind of skin cancer that starts in the melanocytes. Melanoma is less common than other kinds of skin cancer. Melanoma is more likely to spread to other areas of the body if it isn’t diagnosed and treated in the early stages.

One of the most significant signs of melanoma is a new lesion on the skin or a lesion that changes shape, color, or size.

Another significant sign is a lesion that looks different from the other spots on the skin (sometimes called the “ugly duckling” sign). You can use the ABCDE rule as a self-assessment help guide to look out for signs of melanoma:

• Asymmetry — One half of the mole doesn’t match the other half.
• Border — The border or edges of the lesion are irregular, blurred, notched, or ragged.
• Color — The color of the lesion may not be consistent and could include various shades or patches of black, brown, white, blue, pink, or red.
• Diameter — The lesion is larger than 6 millimeters in diameter (around one-fourth of an inch).
• Evolving — The lesion changes color, size, or shape.

Some melanoma lesions may not fit the above-mentioned rules. Other signs that could indicate a problem include:

• A sore that doesn’t heal
• A new swelling or redness away from the border of the lesion
• Spreading of pigment (melanin) from the lesion’s border into the surrounding skin
• Change in skin sensation including tenderness, itchiness, or pain
• Any change in the mole’s surface such as oozing, bleeding, scaliness, or a bump or lump

Basal cell carcinoma

Basal cell carcinoma is one of the most common types of skin cancer. About 8 out of 10 skin cancers are basal cell carcinomas. It begins in the basal cells of the epidermis (lower part) and tends to grow slowly. If basal cell carcinoma isn’t treated, it can grow into surrounding areas and invade nearby tissues such as bone underneath the skin. Basal cell carcinoma usually occurs in areas of the body that are often exposed to the sun such as the neck, head, and face.

Basal cell carcinoma on your scalp may look like:

• A firm, flat, yellow or pale area that may resemble a scar
• Small, red or pink, shiny, translucent, pearly bumps that may have brown, black, or blue areas
• Reddish, raised patches that may itch
• Open sores (possibly with crusted areas or oozing) that don’t heal or recur after healing
• Pink growths with raised edges and a sunken area in the center and from which abnormal blood vessels may spread out

Squamous cell carcinoma

About 2 out of 10 skin cancers are squamous cell carcinomas. They start in the upper or outer part (flat cells) of the epidermis. They commonly occur in areas of the body that are more frequently exposed to the sun. They may also occur in chronic sores of the skin, scars, or actinic keratoses.

Squamous cell skin carcinoma on the head may look like:

• Scaly or rough red patches that may bleed or crust
• Raised lumps or growths that have a sunken central area in some cases
• Growths that resemble warts
• Open sores (possibly with crusted areas or oozing) that don’t heal or recur after healing

The lymph nodes in your parotid gland and neck are much more likely to be affected with squamous cell carcinoma. Squamous cell carcinomas are also more likely than basal cell carcinomas to grow into deeper skin layers and spread to other body parts.

Diagnosis of scalp cancer

To diagnose skin cancer on your scalp, your health care provider may:

• Examine the skin on your scalp to find out whether the changes in your skin are likely due to cancer
• Perform a skin biopsy where they remove a small sample of the suspicious skin and send it to a lab for testing

If you have scalp cancer, your health care provider may recommend additional testing to determine the stage of skin cancer, especially for melanoma and squamous cell cancer. Additional tests may include imaging studies to examine nearby lymph nodes for any signs of carcinoma or a biopsy of a lymph node (called a sentinel lymph node biopsy).

Treatment options for skin cancer on the scalp

Treatment options for skin cancer on the scalp depend upon the type, depth, location, and size of the cancer. Small cancers may be removed completely during the initial biopsy of the skin. If the scalp cancer needs additional treatment, here are some other treatment options:

• Freezing — The health care provider may freeze the small, early cancer using liquid nitrogen. This procedure is also known as cryosurgery.
• Excisional surgery — The health care provider cuts off the skin cancer along with some surrounding healthy skin on the scalp.
• Mohs surgery — In this procedure, the health care provider removes cancer in layers (one layer at a time) and simultaneously examines the layer under a microscope until there are no abnormal cells left. This surgery is usually done to remove difficult-to-treat or larger and recurring scalp cancer.
• Curettage and electrodesiccation — In this procedure, the health care provider scrapes away layers of malignant cells using a curette (a device with a circular blade) after removing the growth. They then destroy any remaining malignant cells using an electric needle.
• Radiation therapy — Health care providers use this option in cases when they can’t completely remove the cancer during surgery.
• Chemotherapy — If the cancer is only present in the top layers of the skin on your scalp, you may be able to apply lotions or creams that contain anti-cancer ingredients directly to your skin. If the cancer has spread to other areas of your body, your health care provider may suggest systemic chemotherapy.
• Photodynamic therapy — This treatment helps destroy cancer cells in the skin by combining drugs and laser light (the drugs make the cancer cells sensitive to light).
• Immunotherapy — For people with advanced-stage skin cancer that can’t be treated with radiation therapy or surgery, health care providers may suggest immunotherapy.

Takeaway

Skin cancer is one of the most common types of cancers. If there is skin cancer on the scalp or anywhere else on the body, knowing its type can help to understand treatment options and what to expect.