Hairy scalps are generally difficult areas to examine for
skin cancers but you should at least examine the scalp margin, particularly
over the forehead. As hair lines recede these areas are prone to solar
keratoses, SCC in situ and basal cell carcinomas. Melanomas are less common and
may be confused with pigmented seborrheic keratoses which are also commonly
found at the scalp margin. With the fashion for close cropped hair in males it
becomes easier to examine the hairy scalp but it also means these patients are
not getting the solar protection from their hair that they once enjoyed! The
patient above had just had a close side haircut which made this lesion more
easily seen and diagnosed. It was still a thin, 0.3mm melanoma which was
subsequently excised with 1 cm margins. The prognosis is excellent as is
usually the case when melanomas are diagnosed early. However you will not find
them if you don’t look!
