Skin cancer on scalp

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Skin Cancer on the Scalp: An Overview

Prevalence and Types of Skin Cancer on the Scalp

Squamous Cell Carcinoma (SCC) on the Scalp

Squamous cell carcinoma (SCC) is a common type of skin cancer that can occur on the scalp. In African American (AA) patients, SCC is the most prevalent skin cancer, although it typically affects sun-protected areas rather than sun-exposed regions like the scalp. However, cases of SCC on the scalp have been reported, particularly in individuals with chronic inflammatory conditions such as folliculitis decalvans. SCC on the scalp can present as large, exophytic masses and may be associated with chronic scarring and inflammation rather than sun damage.

Basal Cell Carcinoma (BCC) on the Scalp

Basal cell carcinoma (BCC) is another type of skin cancer that can develop on the scalp. It is more common in women under the age of 50 and tends to occur in sun-exposed areas. In a study of 197 female scalp tumors, 77% were identified as BCCs, highlighting its prevalence in this demographic. BCCs on the scalp can also arise in areas of previous trauma, as seen in a case involving an Asian Indian female.

Melanoma on the Scalp

Melanoma, although less common on the scalp compared to other body sites, can occur and is often associated with a worse prognosis. Scalp melanomas are more frequent in older, bald men and can be more challenging to treat due to their aggressive nature and the complex anatomy of the scalp.

Risk Factors and Challenges in Diagnosis

Risk Factors

Several risk factors contribute to the development of skin cancer on the scalp. Chronic inflammation and scarring, as seen in conditions like folliculitis decalvans, are significant risk factors for SCC in AA patients. For BCC, previous trauma and sun exposure are notable risk factors, particularly in individuals with lighter skin tones. Additionally, radiation exposure during childhood has been linked to an increased risk of developing skin cancer on the scalp later in life, especially when combined with sun exposure.

Diagnostic Challenges

Diagnosing skin cancer on the scalp can be challenging due to the unique anatomical features and the potential for delayed detection. Scalp tumors often present with a broad and heterogeneous clinical spectrum, making early diagnosis difficult. Biopsies may have limitations in adequately sampling large or complex lesions, which can lead to underdiagnosis or misdiagnosis. Therefore, a high index of suspicion and thorough clinical evaluation are essential for early detection and treatment.

Treatment Approaches

Surgical Interventions

Surgical resection remains a primary treatment modality for scalp skin cancers. Mohs micrographic surgery is often employed to maximize cure rates and minimize recurrence, especially for complicated carcinomas. In cases of invasive skin cancer involving the scalp and calvarium, wide resection with craniectomy and reconstruction using microvascular free tissue transfer has been shown to be effective, with low morbidity and high patient satisfaction.

Radiotherapy

Radiotherapy is recommended for localized cutaneous SCCs without lymph node involvement, as well as for patients who refuse surgery or have poor general medical status. It can also serve as an adjuvant treatment for incompletely excised lesions or as palliative care for extensive tumors.

Conclusion

Skin cancer on the scalp presents unique challenges in terms of diagnosis and treatment. SCC and BCC are the most common types, with risk factors including chronic inflammation, previous trauma, and sun exposure. Early detection and interdisciplinary management are crucial for improving outcomes. Surgical resection, often combined with radiotherapy, remains the cornerstone of treatment for these malignancies.