C. Xie ,Y. Pan , C. McLean , V. Mar , R. Wolfe , J.W. Kelly
Introduction: Scalp melanoma has been described to have
a worse prognosis than melanoma elsewhere, though the
reasons for this are poorly understood. We set out to explore
the clinical and histologic features of scalp melanoma, to
identify potential reasons for the poor prognosis associated
with melanomas at this site. Method: All primary cutaneous head and neck melanoma cases presenting to the Victorian Melanoma Service (VMS) from 1994 to 2014 were identiﬁed. Cases were categorised into anatomic subsites – scalp, face, neck and ear. Patient and tumour characteristics were subsequently compared
between scalp and other head and neck melanoma.
Results: There were 6400 melanomas managed at the VMS
during the study period. 922 invasive and 547 in-situ head
and neck melanomas were included in the study. Of these,
there were 244 invasive and 62 in-situ scalp melanomas.
Patients with scalp melanoma were older and more often
male, when compared to those with other head and neck
melanoma. Invasive scalp melanoma was independently
associated with desmoplastic and nodular tumour subtypes,
greater Breslow thickness, and higher rate of satellite
metastases. They tended to be non-pigmented, grew more
rapidly, and were more often not noticed by the patient,
their family or doctor.
Conclusion: The scalp is not an uncommon site for melanoma.
It often presents atypically, with aggressive histologic
features. It is frequently overlooked by patients, their families
and doctors. Earlier detection of these lesions, facilitated
by a better understanding of their presenting features,
should help to reduce their high case-mortality.