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An 89-year-old woman presents with a scalp lesion for which her hairdresser suggested she seek evaluation. The patient was unaware of its presence, stating that the site neither itches nor bleeds. She is fair-skinned and admits to ample past sun exposure. She denies prior history of skin cancer but was treated in the past for “pre-skin cancers.” Examination reveals a hyperpigmented, slightly elevated plaque of the frontal scalp measuring 1.5 cm in diameter.
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A shave biopsy was performed and histopathology revealed melanoma with a depth of at least 1.15 mm and Clark level IV depth of invasion. A dermal mitotic rate of 2 mitoses/mm2 was reported. The patient underwent wide excision.
Risk factors for the development of melanoma of the head include fair skin and sun exposure.1 Advanced age and location on the scalp portend a poor prognosis.2 The 5-year survival rate for those with melanoma of the scalp is 66%, as opposed to >80% for those with melanoma of the face and neck.
Melanoma of the scalp is often fast growing and overlooked, two factors that undoubtedly account for the high mortality rate.3 Because of their location on the scalp, hairdressers play a valuable role in the detection of this melanoma, as exemplified by this case and others.4
Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He practices dermatology in Hazleton, Pennsylvania.
References
- Cheriyan J, Wernberg J, Urquhart A. Head and neck melanoma. Surg Clin North Am. 2014;94:1091-1113.
- Kadakia S, Chan D, Mourad M, Ducic Y. The prognostic value of age, sex, and subsite in cutaneous head and neck melanoma: a clinical review of recent literature. Iran J Cancer Prev. 2016;9:e5079.
- Xie C, Pan Y, McLean C, Mar V, Wolfe R, Kelly JW. Scalp melanoma: distinctive high-risk clinical and histological features. Australas J Dermatol. 2016 Jan 14. [Epub ahead of print]
- Pillemer BB, Pugliano-Mauro MA, Ferris LK, Patton TJ. Three cases of scalp melanomas discovered by hairdressers. J Clin Aesthet Dermatol. 2013;6:32-34.
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