Early-Stage Scalp Cancer - Causes, Types, Diagnosis, and Treatment

Introduction

Scalp cancer is a common type of skin cancer, accounting for 13 percent. It occurs most commonly in sun-exposed areas. Scalp cancer is hard to spot and should be checked regularly. However early diagnosis and treatment can cure the lesion.

What Are the Causes of Scalp Cancer?

The leading cause of scalp cancer is over-exposure to UV (ultraviolet) radiation from the sun or tanning beds, especially among bald or thin-haired persons. Radiation therapy of the head and neck area can also lead to scalp cancer.

Who Is at Risk of Scalp Cancer?

• Fair skin tone, light-colored eyes, and red or blonde hair are more easily to develop a sunburn or freckles.

• A subjective history of sunburns.

• A personal or family history of skin cancer.

• Too much sun exposure and no skin protection with sunscreen or clothing.

• People in high-altitude or hot climates.

• Presence of multiple abnormal moles.

• Presence of precancerous skin lesions such as actinic keratosis (precancerous rough and scaly skin spots or patches found on sun-exposed areas).

• Immunocompromised patients as in HIV (human immunodeficiency virus) or under immunosuppressant therapy.

• History of radiation therapy for skin disorders.

• Exposure to certain chemicals such as Arsenic.

What Are the Scalp Cancer Symptoms?

Scalp cancer is the abnormal proliferation of skin cells on the scalp, usually in more sun-exposed areas. Overexposure to the sun, changes the DNA (deoxyribonucleic acid) of the skin cells, causing cancer.

Skin cancer develops in the superficial skin surface (epidermis). The epidermis is made of basal cells, squamous cells, and melanocytes. Therefore, scalp cancer can involve any of these three cells and thus different cancers on the scalp are- basal cell cancer, squamous cell cancer, and melanoma.

1. Basal Cell Carcinoma

Basal cell cancer is the most commonly occurring skin cancer. Almost eight out of ten patients with skin cancers are diagnosed with basal cell cancer. It develops slowly from the basal cells of the epidermis. When left untreated, basal cell cancer grows and invades the surrounding tissues and bone beneath the skin. Basal cell cancer usually occurs in sun-exposed areas such as the head, face, and neck.

Clinical Features of Basal Cell Carcinoma of the Scalp:

Early basal cell carcinoma scalp appears as a flat, firm, yellow, or pale area resembling a scar. It progresses as small, pinkish-red, translucent, raised, itchy bumps. These bumps burst and develop open sores that do not heal or relapse after healing. There may be pinkish growth, elevated edges, and a depressed central area from which atypical blood vessels spread out in severe stages.

2. Squamous Cell Carcinoma

It is the second most common skin cancer. They develop from the upper flat cells of the epidermis. They commonly occur in sun-exposed areas and chronic skin infection, scar, or actinic keratosis.

Clinical Features of Squamous Cell Skin Cancer on the Scalp:

Rough red scaly patches that bleed or crust. This progresses to raised lumps or growths with a depressed central area. These raised swelling or growths resemble a wart. As the patches break open, they create open sores that do not heal or relapse after healing.

3. Melanoma on the Scalp

Melanoma, also known as cutaneous melanoma or malignant melanoma, is skin cancer of the melanocytes. Melanoma is less common than basal and squamous cell cancer. However, melanoma spreads to other areas if it is not diagnosed and treated at the earliest. The characteristic signs of melanoma include a new skin lesion, a lesion that changes shape, size, and color.

Self-assessment of melanoma is done using the ABCDE rule.

• Asymmetry: One part of the mole does not counterpart the other part.

• Border: Irregular, notched, blurred, or ragged boundaries or edges.

• Color: The color can vary from white, black, brown, pink, red, or blue shades.

• Diameter: The lesion is bigger than 6 mm in diameter.

• Evolution: The lesion keeps changing its size, shape, and color.

Clinical Features of Scalp Melanoma:

An ulcer that does not heal. A new lesion may develop from the border of the lesion. The melanin pigment spreads from the edge of the lesion to the surrounding skin tissues. It may be accompanied by pain, tenderness, or itch. The mole surface may ooze and bleed or produce scales, bumps, or lumps.

How Is Scalp Cancer Diagnosed?

Scalp cancer is diagnosed using:

• Examine the skin on the scalp for any changes and growth in the skin using a dermatoscope, a magnifying glass used by a dermatologist.

• A skin biopsy from the suspicious site.

• Biopsy of a lymph node to examine the involvement of lymph nodes.

How Is Scalp Cancer Treated?

Scalp cancer treatment depends on the lesion's type, location, depth, and size. Treatment options include:

• Cryosurgery: It is a procedure of freezing small, initial cancer with liquid nitrogen.

• Surgical Excision: Completely remove the lesion with some healthy surrounding scalp tissue.

• Moh’s Surgery: In this surgery, the lesion is removed in layers and examined under a microscope until no abnormal cells are left. This surgery is performed for complex, large, and recurring cancer of the scalp.

• Curettage and Electrodessication: After removing the growth, the remaining layer is scraped off using a curette and then destroyed using an electric needle.

• Radiation Therapy: In cases where the lesion cannot be completely removed during surgery.

• Chemotherapy: If the cancer is present on the superficial scalp, topical lotions or creams targeting the cancer cells are prescribed. Systemic chemotherapy may be suggested when cancer has spread to other body parts.

• Photodynamic Therapy: This is a combination of drugs and laser light to kill abnormal cells.

• Immunotherapy: For patients with advanced-stage skin cancer where radiation therapy or surgical procedures do not cure the lesion, immunotherapy is prescribed.

How to Prevent Scalp Cancer?

The best way to prevent scalp cancer:

• Cover the head with a hat or other headcover.

• Apply sunscreen on the scalp.

• Avoid tanning beds.

• Limit sun exposure time.

What Is the Prognosis of Scalp Cancer?

• Basal cell carcinoma has an excellent prognosis and is often curable.

• Squamous cell carcinoma has a good prognosis and local and regional recurrence.

• Melanoma of the scalp has a worse prognosis than many types of melanoma.

Conclusion

Scalp cancer is the abnormal growth of the scalp tissue, which is often hard to spot but requires attention and early intervention. It is common in people who are overexposed to UV (ultraviolet) radiation. When a person spends more time outdoors, regular checking of the scalp and the body is required. It is essential to detect scalp cancer early as treatment at this stage is stress-free and more effective.