Skin cancers can appear on any part of the body. However, those areas exposed to the sun on a regular basis are the most common locations of both melanoma and non-melanoma skin lesions. Patients with significant hair loss may be at increased risk for developing tumors on the hairless sections of their scalp. But cancerous lesions can be present even on skin that features a full head of hair. This means the scalp is an area that shouldn’t be overlooked in a full body skin exam to identify suspicious moles. Non-melanoma cancers and pre-cancerous lesions called actinic keratoses can be removed from the scalp using a variety of surgical techniques. These will leave a small scar if the cancer is caught early. For balding patients, this scar may be visible. For those with hair, it will usually not be noticeable.
Melanoma Cancer of the Scalp
There are two serious issues with melanoma lesions that affect the scalp. First, melanoma tumors of the scalp (and neck) have a much worse prognosis than lesions on other areas of the body such as the face. Originally, dermatologists believed this was because malignant moles on the scalp were going undetected for longer than moles on more visible areas. However, it now seems that the scalp location itself is somehow linked to a more aggressive progression of the cancer. Only six out of 100 melanoma patients present with a tumor on the scalp or neck. But these patients make up 10% of the deaths from melanoma cancer – regardless of the thickness of the tumor at initial diagnosis.
The second problem with melanoma on the scalp is that it makes Mohs surgery (the most effective excision method for this cancer) difficult to perform. Any cut to the scalp tends to bleed profusely. Managing this bleeding and keeping the surgical field clear so the dermatological surgeon can operate is challenging.
The Mohs procedure requires shaving off tiny portions of progressively deeper tissue for microscopic examination. This means the surgery can take some time. Tumescent anesthesia similar to that used in liposuction may be injected to make the tissue stiff and reduce both bleeding and pain. The hair in the area around the tumor may need to be trimmed down to keep hair strands out of the way during the procedure. Elastic compression bandages are generally applied after a scalp surgery to prevent excessive post-operative bleeding. Patients may need special post-procedure instructions to care for their scalp during the healing phase.