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Hair May Impact Ability to Detect Scalp Melanomas

Hair coverage may impact the ability to detect melanomas on the scalp, according to the findings of a recent poster abstract presented at the 2020 American Academy of Dermatology Virtual Meeting Experience.

While scalp melanomas only account for 3% to 7% of all cutaneous melanoma cases, they are usually thicker, have a higher risk for brain metastasis, and poorer prognosis compared with melanomas on other body sites, the researchers said. They performed a multicenter, observational, retrospective study to determine the epidemiology, hair coverage, and visibility of scalp melanomas and correlated these features with Breslow thickness, ulceration, and mitotic rate.

The study included all consecutive primary scalp melanomas that were photographed preoperatively at 4 pigmented lesions referral centers in Australia and Italy. Hair coverage (hairy vs thinning vs bald) and visibility (hairless/hairline vs hair covered) were assessed by 2 evaluators and compared according to the proportion of invasive melanomas, Breslow thickness, presence of ulceration, and mitotic rate.
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The researchers found that 40.7% of melanomas on the scalp were first noticed by a doctor, whereas 23.9%, 8.8%, and 3.5% were first noticed by the patient, a relative, or a hairdresser, respectively. Data was missing for 26 patients. Among the 4 cases identified by a hairdresser, 3 were invasive melanomas.

Thinner melanomas were more often identified by physicians compared with relatives, patients, and hairdressers combined (Breslow thickness in situ [0.3 mm] vs 1.0 [0.3-3.7mm], respectively). In addition, the researchers found that hair covered melanomas were more frequently detected by relatives, patients, or hairdressers than by a physician.

Other findings reported in the abstract included a male predominance, with most cases easily visible on the scalp. In addition, hair covered melanomas were more frequently invasive and of subtypes other than lentigo maligna (LM) or lentigo maligna melanoma (LMM).

“LM/LMM on the scalps of elderly individuals with alopecia and photodamage is usually detected before becoming invasive,” the researchers said. “Other subtypes on scalps of younger individuals are more frequently concealed by hair and usually detected later at an invasive phase.” They concluded routine examination of the scalp should be encouraged regardless of hair coverage, especially among high-risk patient groups.

Limitations of the study include that some LM may have been considered “melanoma in situ, subtypes unspecific” on histopathology, and that Breslow thickness is an indirect indicator of diagnosis delay, which can also be influenced by rate of growth and melanoma subtype.


Pereira AR, Collgros H, Hirata S, et al. Melanomas of the scalp: Is hair coverage preventing early diagnosis. Abstract presented at: 2020 American Academy of Dermatology Virtual Meeting Experience; June 12-14, 2020.


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