Heads Up for Scalp Melanoma

May 2014 | Volume 13 | Issue 5 | Editorials | 525 | Copyright © May 2014

Deborah S. Sarnoff MD FAAD FACP

It brings me great pleasure to introduce this edition of the JDD highlighting articles on skin cancer. I’d like to take this opportunity to make it personal – and share an important message with you.
Last year my hairdresser discovered a “black mole” on the vertex of my scalp. Terrified, I asked her to snap a quick photo with my cell phone. Looking at the photo and magnifying the spot by manipulating the screen with my fingers, I started trembling. The wonders of teledermatology revealed most of the classic ABCDE warning signs of malignant melanoma.
It dawned on me how utterly ironic it was that I, a dermatologist and Mohs surgeon, specializing in the treatment of skin cancer, had no idea there was a potential melanoma atop my head. I, who performed the most meticulous total body exams on my patients, including the scalp, had never asked anyone to check the back of my own scalp.
The lesion was subsequently excised in its entirety. Fortunately, it proved to be a benign blue nevus. But this frightening firsthand experience was the impetus for me to ask The Skin Cancer Foundation to help me found the “Heads Up” program. I would like to invite all of the readers of the JDD to join us in the fight against melanoma by promoting prevention and early detection.
Scalp melanomas are the deadliest of all. One nationwide study found that people with scalp and neck melanoma die from the disease at nearly twice the rate of people with melanomas elsewhere on the body.1 In fact, although only six percent of melanoma patients have their primary lesion on the scalp and neck, they account for 10 percent of all melanoma deaths.2 Why are scalp melanomas more lethal? One reason may be a delay in diagnosis because of their location, in an area usually hidden by hair. Early detection of melanoma usually results in complete cure, however melanoma found at an advanced stage may be curable less than 15 percent of the time. The biology of the melanoma itself, or the environment of the scalp may also play a role in its tendency to metastasize.3 The scalp is well vascularized; the lymphatic drainage is varied and complex. It may be that melanoma in this location can easily spread to the brain, making it more aggressive.4
Hair professionals are in a unique position to detect skin cancers on the scalp because they have a natural view of difficult-to-see areas during a salon visit. They see their clients on a regular basis, and may frequently discuss health-related topics, such as wellness, illness, diet, and medical care.
A recent survey of 203 hair professionals in Houston, Texas, published in the Archives of Dermatology, investigated skin cancer knowledge, attitudes, and behaviors in the salon, finding that hair professionals who were competent at looking at their own moles were more likely to look at their clients’. Hair stylists who had a personal history of skin cancer or knew someone who had skin cancer were also more likely to look at clients’ skin.5
In 2014, The Skin Cancer Foundation’s Heads Up! program was founded. The program gives dermatologists the tools to educate local beauty professionals about skin cancer and its warning signs through empowering and enjoyable events. Hair dressers, barbers, massage therapists, and aestheticians see far more of the scalp and posterior neck than dermatologists. By participating in this program, these “first responders” will be prepared to give a “heads up” to their clients if they see something suspicious, and encourage them to visit a dermatologist in a timely manner.
If you would like to host a Heads Up! event in your community, simply go to The Skin Cancer Foundation website (www.skincancer.org) and join. You will receive a Heads Up! PowerPoint presentation and script, which reviews the ABCDEs of melanoma and teaches hairdressers how to approach the client. You will find an invitation template and a step-by-step guide on how to organize and publicize your Heads Up! event to make it a success.
In my opinion, a skin cancer educational program targeting hair professionals has the potential to save many lives by increasing the early detection of melanoma in high-risk anatomical areas such as the scalp and neck. Hair professionals, including