Skin Cancer on Scalp: Overview and More

Skin cancer is the most common form of cancer in the United States, with 1 in 5 Americans estimated to develop it in their lifetime. Most scalp tumors are benign—in fact, only 1-2% are malignant and 13% of malignant skin cancers affect the scalp.

Some people are at higher risk of developing skin cancer; however, it can affect anyone. It can affect all skin tones and is most likely to occur in areas of the skin that are exposed to the sun.

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Types of Skin Cancer on the Scalp

Different types of skin cancer can develop on your scalp. The two most common skin cancer types, basal cell carcinoma and squamous cell carcinoma, are considered highly curable.

Melanoma is a rarer and more aggressive form of skin cancer.

Basal Cell Carcinoma

Basal cell carcinoma (non-melanoma malignancy) is the most common form of skin cancer. It starts in the basal cell layer of the epidermis (the outer three layers of the skin). 

These tumors are most commonly found in areas exposed to the sun, such as the scalp, head, face, and neck.

Basal cell carcinomas account for approximately 41% of all benign and malignant scalp tumors.

Squamous Cell Carcinoma

Squamous cell carcinoma (non-melanoma malignancy) is a type of skin cancer that begins in the squamous (flat) cells in the outer part of the epidermis. It is the second most common form of skin cancer, with more than 1 million cases diagnosed in the U.S. each year.

If left untreated, squamous cell carcinoma can be aggressive and potentially dangerous.

Melanoma

Melanoma is a type of skin cancer that is less common than basal and squamous cell carcinomas, and it is the deadliest of these three types. It can spread more rapidly to other organs if left untreated. 

Of primary melanomas, 3-6% are located on the scalp.

Rarer Types

Types of skin cancer less commonly seen include Kaposi sarcoma, Merkel cell carcinoma, specific types of tumors that start in hair follicles or skin glands, cutaneous lymphoma, and certain types of sarcomas. These comprise less than 1% of all skin cancers.

Skin Cancer Doctor Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

Skin Cancer on Scalp Symptoms

Depending on the type of skin cancer, the symptoms and presentation can differ. Non-melanoma skin cancers often present with non-healing skin lesions that look unusual or hurt/bleed/crust/scab for more than four weeks.

Basal cell carcinoma symptoms:

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
Growth with raised edges and an area that dips in the center

Squamous cell carcinoma symptoms:

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

The Ugly Duckling

The Ugly Duckling concept is a warning sign and method to help identify melanoma. The idea is that most normal moles on your body look similar to each other. However, melanomas stand out like ugly ducklings when compared to your other moles.

If you check your moles regularly, you will become familiar with their normal appearance so you can recognize changes, making it easier to spot ugly ducklings. 

Other melanoma symptoms include:

A mole that changes shape, color, size, 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

ABCDE Procedure

If you are unsure of what to look for when checking your moles, then follow the ABCDE procedure:

Asymmetrical: Refers to the shape of the mole. Usually, moles are relatively even in shape, with each side being quite 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 an even color. Melanomas are often uneven in color, potentially containing different shades of brown, black, or pink. 
Diameter: Most melanomas are over 6 millimeters (mm) wide, while most moles are smaller than this. 
Evolving: Normal moles usually stay the same. Melanomas often change in size, shape, color, or texture.

Causes

Ultraviolet (UV) radiation exposure from the sun or a tanning bed is the most common cause of skin cancer. Your scalp is one of the parts of your body that is most exposed to the sun. This means that it can be a place where skin cancer is commonly found. Therefore, it is essential to protect yourself from UV radiation when outdoors. 

Tanned Skin

If your skin is tanned, it does not mean it is healthy. A tan is your skin's response to injury. Too much exposure to UV rays can cause skin cancer over time. It can also lead to eye cancer and cataracts.

Protect yourself from UV exposure by wearing sunscreen, protective clothing (including a sun hat), and sunglasses when outdoors. 

Although anyone can get skin cancer, you are more at risk if:

You have a fair skin tone
You sunburn easily or have a history of sunburn
You have green or blue eyes
You have red or blonde hair
You have a family history of skin cancer
You have previously had skin cancer
The risk increases with advancing age
You have had past radiation exposure (such as radiation treatment for cancer)
You have a weakened immune system (due to an inflammatory disease, an organ transplant, or HIV/AIDS)
You have Gorlin syndrome, a genetic disorder
Specific medications and treatments for some skin conditions can also increase your risk (such as psoralens and ultraviolet light treatments for psoriasis)

Diagnosis

Diagnosis of skin cancer on the scalp will usually begin with your family healthcare provider. Your practitioner will ask you about your general health, family history, history of sun exposure, whether you use tanning beds, what sun protection you use, and what you have noticed about the changes in your skin. 

Speak to Your Healthcare Provider

If you notice any changes to your skin that you are concerned about, make an appointment with your healthcare provider for a skin exam. 

During your skin examination, your healthcare provider will closely examine the problem area of your skin. They might use a dermatoscope, which works like a magnifying glass over the skin. If your healthcare provider thinks you may have skin cancer, they might refer you to a dermatologist (skin specialist).

You may need a biopsy. During this procedure, a small sample of skin is removed from the affected area for examination with a microscope.

Types of skin biopsies: 

Incisional biopsy: Part of the growth is removed with a scalpel. The full thickness of the skin is removed, and the area is closed with stitches. 
Excisional biopsy: The whole growth, and sometimes a border around it, is removed with a scalpel. The area is closed with stitches.
Punch biopsy: A trephine (a small specialized instrument) is used to remove a small circle of the full thickness of the skin. The area removed is very small, so it may heal on its own, or a few stitches may be required. 
Shave biopsy: A sterile instrument like a razor blade is used to "shave-off" the abnormal-looking growth from the top layer of the skin.

You should receive your results within a few weeks.

Treatment

If you are diagnosed with skin cancer on the scalp, your treatment will depend on several factors. These include:

What type of skin cancer you have been diagnosed with
The severity of skin cancer and how it has grown
The location and spread of skin cancer
If relevant, the stage of skin cancer
Your general health
Other conditions you have and medications you take

Treatment options vary, depending on your individual situation. Many people have surgery for the removal of skin cancer on the scalp and do not require any further treatment.

If you require additional treatment after surgery, it might include:

Your healthcare provider will discuss all your treatment options with you. You may need a combination of treatments. 

In some cases, you may be able to take part in a clinical trial testing a new treatment.

Prognosis

It is essential to try to detect skin cancer on the scalp at an early stage. When identified early, treatment is easier and more effective.

Malignant scalp tumors can be difficult to detect at early stages because they are usually covered by hair.

In the U.S., the five-year survival rate for melanoma in all body areas is 99% when it's detected early.
Across all melanoma stages, the average five-year survival rate is 92.7%.

The earlier melanoma skin cancer is diagnosed, the better the outcome, and it responds very well to cancer treatment. 

Basal and squamous cell carcinomas are often very treatable. Prognosis and survival for most non-melanoma skin cancers is considered to be excellent.

Death from basal or squamous cell carcinomas is very uncommon and may occur if it is diagnosed at a very advanced stage or due to immunosuppression.

Coping

Coping with skin cancer of the scalp is can be different for each person. It can be challenging to come to terms with a cancer diagnosis and to adjust to your life while you are being treated for cancer. It can take a physical, emotional, and social toll on you throughout each stage. 

There is a lot of support available to help you. Your healthcare provider can refer you to a counselor or point you in the direction of a local support group. There are also online support groups and support groups for caregivers. 

A Word From Verywell

If you have any concerns about your skin, notice any new lesions or changes to existing moles, do not hesitate to visit your family healthcare provider. In most cases, the skin issue can be easily treated, but it is better to be safe and catch skin cancer of the scalp as early as possible.

Skin cancer of the scalp can be difficult to notice, and the treatment can be more extensive at later stages. Therefore, it is essential to protect your scalp with sunscreen or a hat when you are going to be exposed to sunlight and UV radiation. 

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