Skin Cancer on the Scalp

Skin cancer can affect your scalp just as it does any other part of the body. These malignant (cancerous) 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.

Types of Skin Cancer Affecting the Scalp

Different types of skin cancer can develop on your scalp. The two most common, called basal cell carcinoma and squamous cell carcinoma, are considered highly curable. Melanoma is a rarer and more aggressive form of cancer that can still be cured if found in the earlier stages.

Basal Cell Carcinoma

Basal cell carcinoma (BCC) is the most common form of skin cancer affecting over 3.5 million people in the United States each year. It starts in the basal cell layer, the innermost layer of the epidermis. 

BCC accounts for around 40% of all scalp tumors. The tumors are commonly found in sun-exposed areas of skin, such as the scalp, head, face, and neck.

Squamous Cell Carcinoma

Squamous cell carcinoma (SCC) is a type of cancer that starts in flat, scale-like squamous cells situated on the surface of the epidermis. It is the second most common form of skin cancer with more than a million cases diagnosed in the United States each year.

Though not as common as basal cell carcinoma, squamous cell carcinoma is more serious because it is more likely to grow and metastasize (spread).

Melanoma

Melanoma is less common than BCC and SCC but is the deadliest of all three types. If left untreated, melanoma can rapidly spread to other organs of the body. 

Between 3% and 6% of all melanomas are located on the scalp. Melanoma can take different forms, including sores, ulcers, and moles; it can also present as a pink or skin-colored bump that may grown and bleed. In some cases, it is colorless.

Uncommon Types

Types of skin cancer less commonly affecting the scalp include Kaposi sarcoma (KS), Merkel cell carcinoma (MCC), cutaneous lymphoma, sebaceous gland carcinoma, and certain sarcomas. These comprise less than 1% of all skin cancers.

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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

Causes and Risk Factors

Ultraviolet (UV) radiation from the sun or a tanning bed is the most common cause of skin cancer.

Your scalp is vulnerable because it is a part of the body most commonly exposed to the sun, particular if you are bald or have thinning hair. With that said, you can still get scalp cancer even with a full head of hair.

Other risk factors for skin cancer include:

• Fair skin tone
• Skin that burns, reddens, or freckles easily in the sun
• Having blue or green eyes
• Having blond or red hair
• Having a large number of moles
• Older age (due to many more years of sun exposure)
• Having a family or personal history of skin cancer
  

Skin Cancer Self-Check

You may be able to detect skin cancer early by performing a skin cancer self-exam. You can do this by yourself, but it usually helps to have a friend or family member look at areas you cannot see (such as the back of your head).

The aim of the self-exam is to look for any skin abnormalities, particularly those that have occurred since your last self-exam. This includes changes in moles. This self-check should be done monthly.

When checking for melanoma, there are five different things to look for, described by the so-called ABCDE Rule:

• Asymmetrical: This refers to the shape of the mole. Usually, moles are relatively even in shape, with each side being relatively symmetrical. Melanomas tend to be uneven and asymmetrical. 
• Border: Melanomas often have an irregular, jagged border, whereas normal moles have a smooth border around the edge. 
• Color: Normal moles tend to have even coloration. Melanomas are often uneven in color and sometimes contain different shades of brown, black, or pink. 
• Diameter: Most melanomas are over 6 millimeters (1/4 inch) wide. Normal moles tend to be smaller than this. 
• Evolving: Normal moles usually stay the same. Melanomas often change in size, shape, color, or texture.

If you think you've found something abnormal on your skin (or are simply unsure what you've found), see your healthcare provider.

Diagnosis

Skin cancer of the scalp is typically diagnosed with a combination of a physical exam and a skin biopsy. As part of the evaluation, the healthcare provider may ask questions about your general health, family history of skin cancer, and other symptoms you may be experiencing.

During the physical exam, the healthcare provider will check for any skin problems, either with the naked eye or a magnifying device called a dermatoscope. If skin cancer is suspected, the healthcare provider will perform a skin biopsy to obtain a sample of tissue to evaluate in the lab.

There are different types of biopsies that may be used based on the size, location, and characteristics of the tumor:

• Incisional biopsy involves the removal of tissue with a scalpel. The full thickness of the skin is removed, and the wound is closed with stitches. 
• Excisional biopsy involves the removal of the entire growth along with a narrow border of tissue (known as surgical margins), Stitches are also needed to close the wound.
• Punch biopsy uses a circular blade known as a punch to remove a small cylinder of skin. The full thickness of skin is removed. Stitches are often used to close the wound.
• Shave biopsy uses a razor blade-like device to shave off the top layer of skin. An adhesive bandage may be all that is needed to protect the wound.

After the biopsy is done, you should receive the results within several days to a couple of weeks.

Treatment of Skin Cancer of the Scalp

If you are diagnosed with scalp cancer, the treatment may vary based on the type of cancer you have, the grade (severity) of the tumor, and the extent to which the tumor may or may not have spread. Your general health may also factor in.

Many people with skin cancer only require surgery to remove the tumor. No further treatment may be needed.

With that said, your hair will need to be shaved around the tumor in preparation for surgery. Once the incision is stitched together, any scar can usually be hidden with surrounding hair. If you are bald, an effort will be made to minimize the appearance of a scar; plastic surgery may be needed.

If additional treatment is needed (typically for advanced malignancies), it may include:

• Radiation therapy
• Chemotherapy (including topical chemotherapy creams)
• Immunotherapy (including topical immunotherapy creams)
• Photodynamic therapy
• Targeted drug therapy

Your healthcare provider will discuss all your treatment options with you. You may need a combination of treatments, particularly if metastasis has occurred. 

Prevention Tips

There is no such thing as a healthy tan. A tan is your skin's response to injury caused by UV radiation. Excessive UV exposure may not only lead to skin cancer but also eye cancer and cataracts.

There are several ways to prevent skin cancer of the scalp and other parts of the body:

• Wear protective clothing when outdoors, including a broad-brimmed hat.
• Avoid spending too much time in the sun, especially around midday.
• Use sunscreen with a minimum sun protection factor (SPF) of 30.
• Be sure to apply sunscreen to your scalp if you are bald or your hair is thinning. This includes the thinning of your part
• Reapply sunscreen every two hours or after swimming or excessive sweating.
  
• Stay in the shade as much as possible.
• Wear wraparound sunglasses that block both UVA and UVB rays.

Prognosis

It can come as no surprise that early diagnosis of skin cancer is linked to better outcomes. But that can be a challenge given that cancer of the scalp often goes unnoticed until the tumor is larger and more advanced,

Even so, treatments today are very effective even in the later stages of the disease. This is evidenced by five-year survival rates, which describe the percentage of people who will live for at least five years following their cancer treatment.

Survival statistics are based on the overall population of people diagnosed with skin cancer in the United States. The numbers are then broken down by those whose cancer has not spread (localized), those whose cancer has spread to nearby tissues (regional), and those whose cancer has metastasized (distant).

For melanoma, the most severe form of skin cancer, the current five-year survival rate breaks down as follows:

• Overall: 93.7%
• Localized: 99.5%
• Regional: 70.6%
• Distant: 31.9%

Summary

Skin cancer can affect the scalp in the same way as any other area of the body. Though bald people or those with thinning hair may be at greater risk due to increased UV exposure, anyone can be affected. The most common types are basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma.

As with other types of skin cancer, cancer of the scalp is diagnosed with a skin biopsy. Although surgical removal of the tumor is often the only treatment needed, advanced cases may require radiation, chemotherapy, or targeted drugs.

When cancer of the scalp is localized, the prognosis is excellent. Even with advanced cases of BCC and SCC, the outlook is generally positive if treated appropriately.

A Word From Verywell

Coping with skin cancer is different for each person. It can be challenging to come to terms with a cancer diagnosis and to adjust to life while undergoing cancer treatment. It can take a toll on your physical and emotional health and well-being. 

There is a lot of support available to help if you have skin cancer. Your healthcare provider can refer you to a counselor or point you in the direction of an online or in-person support group. There are even support groups for caregivers to help avoid burnout.