Skin cancer on the scalp: An overview

There are three main kinds of skin cancer (among other rarer kinds): Squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and melanoma. They can develop on the scalp.

SCC and BCC are the two most common types, but while melanoma is rarer, it’s more likely to spread faster and is therefore considered the most dangerous.

Knowing which kinds of skin cancer affect the scalp and what signs and symptoms to watch for can help you identify and treat it promptly.

What causes skin cancer?

The most common cause of skin cancer is the sun’s ultraviolet (UV) rays. They can affect the DNA of our cells, causing them to divide and grow out of control. This is what leads to cancer. As your scalp is often the most exposed to the sun, it’s a very common area for skin cancer to develop, particularly in bald people.

You can also be exposed to UV rays if you use tanning beds. A 2019 study suggests that using tanning beds is associated with an increased risk of developing melanoma, and the American Academy of Dermatology (AAD) says that it increases the risk of developing BCC by 58% and SCC by 24%.

Although anyone can develop skin cancer, people with more melanin in their skin are at less risk. Melanin is what gives the skin its color and protects it from dangerous UV radiation. Some research, including one 2019 study, shows that people with lighter skin (meaning lower melanin levels) are more at risk of developing melanoma.

What are the symptoms?

The symptoms can vary depending on the type of cancer. However, the most common sign is an unusual change in your skin, like developing a new mole. This can be harder to see on the scalp if you have hair, but it’s important to keep an eye out for.

Catching signs of cancer early means there is a higher chance of treating it effectively.

Basal cell carcinoma

Signs and symptoms include:

• a shiny/pearly bump
• a red patch on the skin that may itch or cause pain
• a sore that doesn’t heal or keeps returning
• a scaly patch with a raised edge

BCC is the most common type of skin cancer, and cases are increasing annually, according to a 2019 review. Looking out for these symptoms can help you identify it early.

Squamous cell carcinoma

A 2020 study suggests that the scalp is an area at high risk of developing SCC. Signs and symptoms may include:

• scaly patches that bleed
• sores that don’t heal
• a wart-like growth that bleeds

SCC is also known for being very itchy and irritating to the skin. It can also spread to other organs more easily than BCC.

Melanoma

A 2021 study noted that scalp melanomas represent 5% of all melanoma cases and have high mortality rates compared to melanomas on other areas of the body.

Melanoma appears as a brown mole-like spot that itches, bleeds, or changes color, size, or shape. An easy way to remember how to identify melanoma is the ABCDE method:

• A: Asymmetry. Do the sides of the mole look different from one another?
• B: Border. Melanomas often have irregular borders.
• C: Color. Is the color of the mole consistent, or does it have different colors through it?
• D: Diameter. Melanomas are often (but not always) over 6 millimeters in diameter.
• E: Evolving. A key feature of melanomas is that they change over time.

Treatment options

There are many treatment options, and treatment might vary depending on the type and stage of cancer. Some common treatment methods include:

• Surgery: Surgery to remove the cancerous tumor is generally the first choice and the most effective way to treat cancer.
• Curettage and electrodesiccation: This is where a healthcare professional scrapes away the skin cancer cells (curettage), and then the area is treated with an electrode (electrodesiccation) to kill any cells that may be left.
• Radiation therapy: This can either be used instead of surgery or after surgery to make sure all cancer cells are gone.
• Topical chemotherapy: Although traditional chemotherapy isn’t normally used for skin cancer, a chemotherapy lotion such as 5-fluorouracil (Carac) might be used to treat BCC and SCC if it’s on the top layer of the skin.
• Immunotherapy: Immunotherapy drugs help your immune system detect and fight cancer cells. Examples include immune checkpoint inhibitors like pembrolizumab and nivolumab. These are usually used to treat melanoma. Immunomodulators like imiquimod (Zyclara) can also treat melanoma, SCC, and BCC.
• Photodynamic therapy: This is where a healthcare professional gives a patient medication to make the cancer cells sensitive to light. They will then use a light or a laser to kill the cancer cells.
• Cryotherapy: This generally treats pre-cancerous conditions. A healthcare professional will freeze the tumor in order to kill the cells.

A healthcare professional can help you to determine the right treatment for you.

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Prevention

Prevention is an important element in reducing skin cancer cases and avoiding the need for treatment. Some examples of things you can do to protect your skin include:

• using sunscreen with an SPF (sun protection factor) of 30+
• wearing a hat outdoors
• avoiding spending too much time in the sun
• avoiding tanning beds

One 2018 study found that behavioral counseling for children, adolescents, and young adults to teach them about sun protection behaviors, including sunscreen use, can help increase these behaviors.

Summary

Skin cancer commonly develops on the scalp because of radiation from the sun. It’s important to keep an eye out for the signs of cancer developing so it can be treated right away. Treatment options include surgery and radiation therapy.

You can also take some steps to prevent skin cancer, including wearing sunscreen of SPF 30+ and avoiding tanning beds.

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