Melanoma of the Scalp

A 60-year-old African American woman presented with an asymptomatic, nonpruritic lesion on the left temporal scalp that bled intermittently. She had noticed the lesion after she used a hair relaxant 5 to 6 months earlier. Since then, the lesion had slowly enlarged. She had a history of type 2 diabetes mellitus and hyper- tension. She denied alcohol consumption and tobacco use.

This 4.7 × 3.5-cm, exophytic, nodular lesion with a dark, hyperpigmented base and large area of ulceration is a melanoma. The patient underwent wide local excision with a 2-cm margin and sentinel lymph node biopsy, which was negative for malignancy. She was considered at high risk for recurrent disease because of the thickness of the lesion and the presence of ulceration; interferon was recommended. The patient chose close observation with physical examination every 3 months; however, she was lost to follow-up.

The incidence of melanoma has risen faster than any other malignancy and is currently the leading cause of death from diseases of the skin.¹ Scalp involvement is a well-known poor prognostic factor, because of the rich vascular and lymphatic supply.²

Tumor thickness and ulceration are the key histologic features associated with prognosis. Early detection is the most important factor in survival.³ Diagnosis of melanoma of the scalp may be delayed because the lesion is often hidden by hair.

References:

1. Lee KJ. Essential Otolaryngology: Head and Neck Surgery. 8th ed. New York: McGraw-Hill; 2003:661-668.
2. Benmeir P, Baruchin A, Lusthaus S, et al. Melanoma of the scalp: the invisible killer. Plast Reconstr Surg. 1995;95:495-500.
3. Cummings CW, Fredrickson JM, Harker LA, et al. Otolaryngology--Head and Neck Surgery. 3rd ed. St Louis: Mosby; 1998:502-509.