What Does Scalp Melanoma Look Like?

Hi, my name is Jessica Dorsey and I’m a board-certified dermatologist and fellowship-trained Mohs surgeon at U.S. Dermatology Partners. Today I’m going to be talking to you about scalp melanomas. Scalp melanomas usually appear as a brownish or black spot. Most of the time they're flat but sometimes they can be raised. A lot of times they're asymptomatic but sometimes they can be itchy, or they can bleed. I usually recommend following the ABCDEs of melanoma which stands for A, asymmetry, where the lesion will not be a mirror image of itself side to side. B stands for border, so usually scalp melanomas have an irregular border. C stands for color so you can have a color change within the lesion or multiple colors within the same lesion such as brown, black, red, blue. D stands for diameter greater than six millimeters or greater than a pencil eraser and E stands for evolving or changing.
So, scalp melanoma is actually pretty rare. It comprises about two to five percent of all skin melanomas. It's usually more commonly found in elderly men.
Since scalp melanomas tend to behave a little bit more aggressively, the treatment is usually surgical. This can be excised via more traditional methods such as a wide local excision or it may require Mohs surgery which is a specialized form of skin cancer removal where the doctor will take a thin layer of skin with safety margins, take it to the lab while the patient is waiting and then they will be able to look at it under the microscope to be able to determine if there are clear margins. The beauty of Mohs is that it has a higher cure rate and we are able to use special stains called immunohistochemistry stains to be able to see the melanoma more clearly under the microscope.
What I always tell my patients is to perform monthly self-skin exams at home. This means usually on the first of the month is what I tell my patients so it's easy to remember. Take a look at your entire body in the mirror and if you're trying to take a look at your scalp if you have hair try to use a comb or your fingers to part the hair so that way, you're able to visualize any of those spots. If you see something abnormal then you're going to want to go in for a spot check appointment with a board-certified dermatologist so they can take a look and evaluate the lesion. We also recommend that if you've had a history of skin cancer you may want to be seen more often with a board-certified dermatologist or if you haven't had skin cancer, it might be wise to have a yearly skin exam and then I always tell my patients even if it's earlier than your scheduled full-body skin exam and you notice a suspicious spot, please come in for a spot check appointment so we can evaluate the lesion and catch whatever it is early.