Skin Cancer On The Scalp
Susan Bard, MD, is a board-certified dermatologist in New York City.
Skin cancer can affect your scalp just as it does any other part of the body. These malignant lesions can include basal cell carcinoma, squamous cell carcinoma, or melanoma. However, they often go unnoticed because skin cancer on the scalp can be masked by hair or located on a part of the scalp that isn’t easy to check.
Sun exposure is the most common cause of skin cancers, including those on the scalp, which account for 13% of all skin malignancies.
This article describes the different types of cancers affecting the scalp as well as how they are diagnosed and treated. It also offers prevention tips and instructions on how to perform a self-exam.
Squamous Cell Skin Cancer Of The Head And Neck Treatment
Surgery is the preferred management method for the majority of squamous cell skin cancers. Low-risk, early stage, small squamous cell cancers can be removed by Mohs surgery, which is a technique that spares normal tissue through repeated intraoperative margin testing, removing only the cancer and leaving adjacent normal tissue. Excision, curettage and desiccation, and cryosurgery can also be used to remove the cancer while sparing normal tissue. Radiation alone is an alternative for low-risk tumors when surgery is not desirable because of cosmetic concerns or medical reasons.
Large tumors and tumors with nerve or lymph node involvement are not suitable for Mohs surgery and require removal of at least 5-millimeter margins of normal tissue around the cancer and neck dissection for involved lymph nodes. Larger tumors require reconstruction, which can be done at the time of surgery if margin status is clear. Reconstruction should be staged when margins status is not clear.
Patients with high-risk tumors should meet with a radiation therapist to discuss postoperative radiation. Chemotherapy may be added to radiation for extensive lymph node involvement or positive margins that cannot be cleared with additional surgery. In patients with high-risk tumors who are not surgical candidates, systemic treatment with both radiation and chemotherapy is used. Such cases require multidisciplinary care by a team of surgeons, radiation oncologists and medical oncologists.
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 .
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Acne Comedones And Pimples
Acne happens when your skin is infected, inflamed, or produces too much oil. This can cause redness, soreness, itching, pimples, and bumps called comedones. These comedones are pores clogged with oil, dead skin cells, and other debris. They can manifest as pimples, whiteheads, or blackheads.
Zits can occur at any age but are more common in adolescence. Breakouts can also be triggered by hormonal changes during menstruation or pregnancy.
Acne usually doesnt have any longterm effects, but in severe cases it can cause scarring.
Where Does Mcc Occur On The Body
MCC primarily occurs on highly sun-exposed skin such as the head/neck and arms , but it can occur anywhere on the body, including sun-protected areas such as the buttock or the scalp under hair.
Solid circles depict MCC tumors that arose on the skin . Open circles indicate MCCs that presented in lymph nodes without an associated primary lesionprimary lesionThe abnormal tissue that appeared first. The majority of Merkel cell carcinoma primary lesions occur in sun-exposed areas. In some cases of MCC the patient has no primary lesion and instead has a nodal presentation . In these cases the primary lesion likely was destroyed by the immune system. . Recent data suggest that patients who present without a primary lesionlesionAn area of abnormal tissue that may be either benign or malignant. originally did have a lesion on the skin, but that their immune system eliminated the tumor. Elimination of the primary lesion is associated with less risk for patients that already have the same stagestagePhysicians determine the stage of cancer by performing physical exams and tests. Stages describe the extent of cancer within the body, especially whether the disease has spread from the primary site to other parts of the body. at presentation .
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Basal Cell And Squamous Cell Carcinomasigns And Symptoms
The most common warning sign of skin cancer is a change on the skin, especially a new growth or a sore that doesn’t heal. The cancer may start as a small, smooth, shiny, pale or waxy lump. It also may appear as a firm red lump. Sometimes, the lump bleeds or develops a crust.
Both basal and squamous cell cancers are found mainly on areas of the skin that are exposed to the sun the head, face, neck, hands and arms. But skin cancer can occur anywhere.
An early warning sign of skin cancer is the development of an actinic keratosis, a precancerous skin lesion caused by chronic sun exposure. These lesions are typically pink or red in color and rough or scaly to the touch. They occur on sun-exposed areas of the skin such as the face, scalp, ears, backs of hands or forearms.
Actinic keratoses may start as small, red, flat spots but grow larger and become scaly or thick, if untreated. Sometimes they’re easier to feel than to see. There may be multiple lesions next to each other.
Early treatment of actinic keratoses may prevent them from developing into cancer. These precancerous lesions affect more than 10 million Americans. People with one actinic keratosis usually develop more. Up to 1 percent of these lesions can develop into a squamous cell cancer.
Basal cell carcinoma is the most commonly diagnosed skin cancer. In recent years, there has been an upturn in the diagnoses among young women and the rise is blamed on sunbathing and tanning salons.
- Raised, dull-red skin lesion
How Can Hairstylists Help
Here I am with my heroes from the hair salon : Manolita Lorenzo , Georgia Megaris and Tasso Megaris .
Hair professionals are in a unique position to detect skin cancers on the scalp because they have a natural view of difficult-to-see areas during a salon visit. They also see their clients on a regular basis, often at monthly intervals, and may frequently discuss health-related topics, such as wellness, illness, diet and medical care.
A 2018 article in JAMA Dermatology found that educating salon professionals about melanoma risk can be beneficial. Previous studies have shown that hair professionals are willing to speak up when they notice a suspicious spot, and the more knowledge they have about skin cancer, the more helpful their input can be.
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What Causes Cancer To Form On Your Scalp
The main cause of all types of skin cancer is sun exposure. Your scalp is one of your body parts exposed most to the sun, especially if you are bald or have thin hair. That means its one of the more common spots for skin cancer.
Other potential causes of skin cancer on your scalp include using a tanning bed and having had radiation treatment on your head or neck area.
The best way to prevent skin cancer on your scalp is to protect your scalp when you go into the sun:
- Wear a hat or other head covering whenever possible.
- Apply sunscreen on exposed areas of your scalp.
Other ways to help prevent skin cancer on your scalp are:
- Avoid using tanning beds.
- Limit your time in the sun.
- Check your scalp regularly to spot any potential cancerous spots early.
Checking your scalp can help stop precancerous lesions from turning into cancer or stop skin cancer from spreading. You can use a mirror to look at the back and top of your scalp more thoroughly. Some pre-cancerous spots may feel like rougher or thicker patches of skin. They may be tender if picked at.
Prevention Of Basal Cell Carcinoma
Because basal cell carcinoma is often caused by sun exposure, people can help prevent this cancer by doing the following:
Using sunscreen Sunscreens Sunburn results from a brief overexposure to ultraviolet light. Overexposure to ultraviolet light causes sunburn. Sunburn causes painful reddened skin and sometimes blisters, fever… read more : At least sun protection factor 30 with UVA and UVB protection used as directed and reapplied every 2 hours and after swimming or sweating but not used to prolong sun exposure
In addition, any skin change that lasts for more than a few weeks should be evaluated by a doctor.
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Where Does Bcc Develop
As the above pictures show, this skin cancer tends to develop on skin that has had lots of sun exposure, such as the face or ears. Its also common on the bald scalp and hands. Other common areas for BCC include, the shoulders, back, arms, and legs.
While rare, BCC can also form on parts of the body that get little or no sun exposure, such as the genitals.
What Does Cancer Of The Scalp Look Like
The symptoms of skin cancer vary by the type of cancer involved. Non-melanoma cancers often cause non-healing lesions that bleed, crust, or scab. By contrast, melanoma is characterized by the appearance of a new spot on the skin or a spot that is changing in size, shape, or color.
Basal cell carcinoma on the scalp can appear as:
- Red raised patches that might be itchy
- Flat and firm, flesh-colored lesions that appear similar to a scar
- Sores that bleed, scab, and either don’t heal or heal and return regularly
- Small, pink, or red pearly bumps that might have blue, brown, or black areas
- Growths with raised edges and an area that dips in the center
Squamous cell carcinoma on the scalp can appear as:
- A firm, red bump on the skin
- Crusted and scaly patches on the skin
- Growths that look like warts
- Sores that bleed, scab, and either don’t heal or heal and return regularly
Melanoma on the scalp can appear as:
- A mole that changes shape, color, or size, and bleeds or develops an irregular border
- A new large brown spot on the skin, sometimes containing dark speckled spots
- A new spot on the skin that changes in size, shape, or color
- A sore that doesn’t heal
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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 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 . 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 dont 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.
Actinic Keratosis Signs And Symptoms
Many people have actinic keratosis , also called solar keratosis, on their skin. It shows that youâve had enough sun to develop skin cancer, and it is considered a precursor of cancer, or a precancerous condition.
Usually AK shows up on the parts of your body that have received the most lifetime sun exposure, like the face, ears, scalp, neck, backs of the hands, forearms, shoulders and lips.
Some of the same treatments used for nonmelanoma skin cancers are used for AK to ensure it does not develop into a cancerous lesion.
This abnormality develops slowly. The lesions are usually small, about an eighth of an inch to a quarter of an inch in size. You may see a few at a time. They can disappear and later return.
- AK is a scaly or crusty bump on the skinâs surface and is usually dry and rough. It can be flat. An actinic keratosis is often noticed more by touch than sight.
- It may be the same color as your skin, or it may be light, dark, tan, pink, red or a combination of colors.
- It can itch or produce a prickling or tender sensation.
- These skin abnormalities can become inflamed and be encircled with redness. Rarely, they bleed.
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What Are Cancers Of The Head And Neck
Cancers that are known collectively as head and neck cancers usually begin in the squamous cells that line the mucosal surfaces of the head and neck . These cancers are referred to as squamous cell carcinomas of the head and neck. Head and neck cancers can also begin in the salivary glands, sinuses, or muscles or nerves in the head and neck, but these types of cancer are much less common than squamous cell carcinomas .
Cancers of the head and neck can form in the:
Oral cavity: Includes the lips, the front two-thirds of the tongue, the gums, the lining inside the cheeks and lips, the floor of the mouth under the tongue, the hard palate , and the small area of the gum behind the wisdom teeth.
Throat : The pharynx is a hollow tube about 5 inches long that starts behind the nose and leads to the esophagus. It has three parts: the nasopharynx the oropharynx the hypopharynx .
Voice box : The voice box is a short passageway formed by cartilage just below the pharynx in the neck. The voice box contains the vocal cords. It also has a small piece of tissue, called the epiglottis, which moves to cover the voice box to prevent food from entering the air passages.
Paranasal sinuses and nasal cavity: The paranasal sinuses are small hollow spaces in the bones of the head surrounding the nose. The nasal cavity is the hollow space inside the nose.
Basal Cell Carcinoma Warning Signs
Basal cell carcinoma typically develops on parts of your body exposed to sunlight but also occasionally occurs in other places.
According to the , warning signs often include:
- an open sore that either doesnt heal or heals and returns
- a lesion that spontaneously bleeds without being picked at or manipulated
- a pink growth with raised edges and a depressed center, sometimes with atypical blood vessels that resemble the spokes of a wheels
- a small pink or red bump thats shiny, pearly, or translucent and may have areas that are black, blue, or brown
- a raised red patch that itches
- a flat and firm area that resembles a pale or yellow scar
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How Is Skin Cancer Diagnosed
Your doctor will examine the area of concern and ask you about your family history, medical history, and sun exposure. If they suspect skin cancer, theyll refer you to a dermatologist.
A dermatologist can perform a biopsy. During this procedure, theyll surgically remove part or all of the spot or mole. This tissue sample will then be sent to a lab for analysis.
If your test comes back positive, you may need to receive additional tests, like imaging and blood tests, to help identify the extent of the cancer. A lymph node biopsy may be performed to see if it has spread to nearby lymph nodes.
How Reduce Your Risk For Cancer
Factors like genetics can influence your risk of getting skin cancer, but the number-one culprit is still the sun. Naturally, the biggest thing you can do is use sun protection all the time. You really have to wear sunscreen every single day, Karen says. When youre actually at the beach or spending a lot of time outside in the suns rays, make sure to reapply every two hours, she says.
As much as we love our SPF, Karen stresses sunscreen alone isnt enough. It should be one component of a smart sun strategy that includes hats, long sleeves, sun-protective clothing, and sitting in the shade, she explains.
If you dont go in the sun, it doesnt guarantee that youll never get skin cancer, but it does greatly decrease your risk of the big three, Day adds.
Be sure to keep up with yearly skin checks. If you have a history of skin cancer, either personally or in your family, your dermatologist might recommend upping them to every six months. And in the meantime, dont be afraid to see your derm about something that looks weird.
McNeill recommends making an appointment to see your dermatologist if a spot a weird bump, sore, mole, or pimple that just wont go away is not healing after a month. You should not have a pimple or a scab or new bump for a month, she says.
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