If you noticed a mole on your hand that looked suspicious, you’d probably know you should have a dermatology specialist check it out. However, you might not regularly and easily see some parts of your body — such as your scalp. Scalp melanoma often goes undetected for longer than other types of melanoma, leading to worse outcomes.

This article aims to raise your awareness about the risk, signs, and treatment of scalp melanoma. You’ll also find pictures to help you get a feel for whether a mole is concerning and learn tips on when to speak to a doctor.

What Is Scalp Melanoma?

Melanoma, the rarest and most serious form of skin cancer, can affect any part of the body. Melanoma starts in the skin cells that produce pigment, called melanocytes. Exposure to radiation from sunlight can trigger melanocytes to become cancerous.

Four main types of melanoma may occur anywhere on the body, including the scalp.

• Superficial spreading melanoma — Usually grows along the skin’s top layer before it penetrates the skin and sometimes has ulceration (broken skin) and bleeding
• Nodular melanoma — Commonly affects the head and neck and usually grows deeper faster, giving it a worse prognosis (outlook)
• Lentigo maligna melanoma — Often grows for years to decades
• Acral lentiginous melanoma — More common in people with dark skin tones than light skin tones

Scalp Melanoma by the Numbers

Although the head and neck accounts for just 9 percent of the skin on your body, 20 percent of melanoma cases occur in this area. Scalp melanoma makes up 35 percent of cases in the head and neck. This makes sense — unless you wear a hat every time you go outside, your scalp receives direct sunlight every day.

Scalp melanoma often goes undetected for longer and has a worse survival rate than other forms of the disease. Just 60 percent of people with scalp melanoma survive 10 years. Scientists have described scalp melanoma as an invisible killer because it’s almost twice as deadly as melanoma on the arms or legs.

Scientists have looked into the reasons scalp melanoma has such a poor prognosis. They believe it’s due to a combination of these factors:

• Poor visibility of the scalp — The skin on your head may be covered by hair and hard to see in a mirror.
• Anatomy of the scalp — The scalp contains a lot of blood vessels, which can spread melanoma to other areas of the body.
• Growth of scalp melanomas — Melanoma on the scalp tends to grow deeper into the skin rather than spread out on top.

Risk Factors for Melanoma

Many different factors put a person at a higher risk of melanoma, including on the scalp. Two major risks include ultraviolet (UV) light exposure and genetics.

Ultraviolet Radiation

The biggest risk factor for melanoma is exposure to UV light, which can come from natural sunlight or tanning beds. UV light damages DNA. People who get more direct sun exposure over their lifetime have the greatest risk of melanoma.

Genetics

Some risk factors for melanoma are out of your control. For example, people with blond or red hair, blue eyes, and lots of freckles or moles have the greatest risk. However, people with darker skin often don’t realize that they’re still at risk, and they can miss skin changes until the disease has become worse.

Furthermore, if others in your family have had melanoma or pancreatic cancer, you may have a gene that increases your risk of melanoma. Certain genetic conditions, such as xeroderma pigmentosum, also put you at a high lifetime risk of skin cancer.

Scalp Melanoma Signs and Symptoms

The signs of a suspicious mole on the scalp are similar to those you should watch for elsewhere on your body. Many people have moles all over that are flat, round, and small and don’t change much over time. These moles are usually normal and aren’t likely to indicate cancer.

If you or a loved one has a new mole on the scalp, take a picture and use the ABCDE rule. The letters of the acronym stand for:

• Asymmetry — One half of the mole doesn’t match the other.
• Border irregularity — The border is jagged, notched, or crusted.
• Color variation — The mole is multicolored.
• Diameter — It’s larger than a pencil eraser (almost a quarter inch, or 6 millimeters).
• Evolving — Color, shape, or texture changes over time.

Hair can often cover an irregular mole on the scalp. That’s why it’s important to have a loved one help you regularly perform skin checks on your scalp and other areas that can be hard to see yourself.

What Is Melanoma on the Scalp Mistaken For?

Not all abnormal moles on the scalp are melanoma. Many less dangerous, more common markings or lesions may present similarly. These include:

• Seborrheic keratosis — This noncancerous skin growth can look similar to melanoma but usually has a waxy, raised appearance and is often itchy.
• Basal cell carcinoma (BCC) — A less aggressive type of skin cancer, BCC usually looks pearly and flesh-colored.
• Psoriasis — A scaly lesion that comes and goes may be a psoriasis flare-up.

Diagnosis of Scalp Melanoma

What happens at the dermatologist’s office when you have a suspicious mole on your scalp? First, your doctor may take a little piece of the mole to look for abnormal melanocytes, using a microscope. This is called a biopsy. The presence of abnormal melanocytes in a superficial (“shave”) biopsy can help during the melanoma diagnosis process.

After being diagnosed, melanoma is assigned a stage. The stage is determined by how deep it is in your skin and whether it has spread to neighboring lymph nodes or organs. Staging may call for another, deeper biopsy of the skin or a biopsy of surrounding lymph nodes. If your melanoma is deeper than about an eighth of an inch (4 millimeters), your doctor may recommend imaging of your whole body due to the risk that the cancer has spread.

The stage of scalp melanoma — varying from stage 1 to stage 4 — will help determine your treatment. (Cancer stages are sometimes noted with Roman numerals, such as “stage III” instead of “stage 3.”)

Treatment of Scalp Melanoma

Skin cancer treatment options for melanoma depend on how much your melanoma has spread into your skin and around your body. For example:

• If your scalp melanoma is at an early stage and hasn’t spread, a surgeon will remove the melanoma with wide margins. This means they’ll remove a bit of normal-looking skin around the mole to help ensure they don’t leave cancer cells behind.
• If your scans showed melanoma has spread to some of your lymph nodes — called sentinel nodes — your doctor will remove them in surgery.

If your cancer has spread to other organs, your treatment may also include some combination of immunotherapy, radiation therapy, and chemotherapy.

Your melanoma treatment will be targeted to your specific circumstances. Communicate with your health care team, including your dermatologist, oncologist, and surgeon, to get your questions answered.

When To See Your Doctor

If you have any concerns about your risk of melanoma, ask your doctor how often you should check your skin. Any new or rapidly changing mole on your scalp, especially if it has ABCDE characteristics, should be considered suspicious. See your dermatologist to get it evaluated.

Talk With Others Who Understand

MyMelanomaTeam is the social network for people with melanoma and their loved ones. On MyMelanomaTeam, members come together to ask questions, give advice, and share their stories with others who understand life with melanoma.

Have you or a loved one been diagnosed with scalp melanoma? What advice would you give to others about checking for skin changes? Share your experience in the comments below, or start a conversation by posting on your Activities page.