Melanoma skin cancer on scalp

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Melanoma Skin Cancer on the Scalp: An Overview

Introduction to Scalp Melanoma

Melanoma is a severe form of skin cancer that can occur on various parts of the body, including the scalp. Although melanomas on the head and neck account for about 20% of all melanoma cases, only 2-5% specifically arise on the scalp. Despite their rarity, scalp melanomas are particularly concerning due to their aggressive nature and poor prognosis compared to melanomas on other body sites .

Epidemiology and Risk Factors

Prevalence and Demographics

Scalp melanomas are more common in older adults, particularly men over the age of 65, likely due to higher rates of androgenetic alopecia and cumulative ultraviolet (UV) damage . Studies have shown that scalp melanomas occur six times more frequently in men than in women. This gender disparity is attributed to factors such as baldness, which increases UV exposure to the scalp.

Histological Characteristics

Scalp melanomas are histologically diverse, including subtypes such as lentiginous melanoma, desmoplastic melanoma, superficial spreading melanoma, and nodular melanoma. These melanomas often present with higher Breslow thickness, ulceration, and a higher mitotic rate, all of which are indicators of a more aggressive disease .

Clinical Presentation and Diagnosis

Symptoms and Detection

Scalp melanomas are often diagnosed at a later stage due to their hidden location and the difficulty in detecting changes beneath hair. Common clinical features include irregular pigmented blotches, blue-white veils, and atypical networks observed through dermoscopy. Reflectance confocal microscopy (RCM) can also reveal irregular meshwork patterns, aiding in diagnosis.

Diagnostic Challenges

The diagnosis of scalp melanoma can be challenging due to its atypical presentation and the potential for misdiagnosis as benign conditions like solar lentigo or actinic keratoses. Therefore, any suspicious lesion on the scalp should be biopsied, with excisional biopsy being the preferred method.

Prognosis and Survival Rates

Poor Prognosis Factors

Scalp melanomas are associated with a worse prognosis compared to melanomas on other body sites. Factors contributing to this include higher rates of tumor ulceration, high mitotic rates, and nodular subtypes . The 10-year survival rate for scalp melanoma is approximately 60%, significantly lower than for melanomas on other parts of the body.

Recurrence and Mortality

Patients with scalp melanoma have a higher risk of recurrence and melanoma-specific death. Studies have shown that the median survival time for scalp melanoma patients is significantly shorter compared to those with melanomas on other sites. This underscores the importance of early detection and aggressive treatment.

Treatment and Management

Surgical Interventions

Surgery remains the primary treatment for scalp melanoma. Achieving adequate excision margins can be challenging due to the anatomical complexity of the scalp. Interestingly, studies suggest that a more conservative surgical approach with 1 cm margins may not negatively impact survival, even for tumors with a Breslow thickness between 1.1 and 2 mm.

Adjuvant Therapies

Adjuvant therapies, including immunotherapy and targeted therapy, are often employed, especially in advanced cases. For instance, anti-PD1 antibody therapy has shown promising results in treating advanced scalp melanoma. Early detection and tailored treatment strategies are crucial for improving outcomes, particularly in elderly patients with comorbidities.

Conclusion

Scalp melanoma, though rare, is a highly aggressive form of skin cancer with a poor prognosis. It predominantly affects older men and is often diagnosed at a later stage due to its hidden location. Early detection, accurate diagnosis, and appropriate treatment are essential for improving survival rates. Ongoing research and awareness are vital to better understand and manage this challenging malignancy.