by Deborah S. Sarnoff, MD
“Dr. Sarnoff, are you aware that you have a black spot on your scalp?” asked Manolita, the woman washing my hair. Here I was in the same salon, in the same chair, with my head in the same sink, with the same woman who, for the past 20 years, has washed my hair during my monthly appointments for a color and cut.
“I don’t think it’s dirt, it’s not washing off,” Manolita said. Then she held up a mirror for me.
“I can’t see anything,” I replied. Two mirrors didn’t help. Suddenly I had an idea: “Can you take my cell phone out of my purse and snap a photo for me?”
Looking at the photo on my iPhone and magnifying the spot by manipulating the screen, I started trembling. I almost fainted right there in the chair. The lesion had most of the classic ABCDE warning signs of melanoma: Asymmetry, irregular Borders, variegated Colors from dark brown to jet black, and large Diameter. (E is for Evolving or changing.) Beginning to panic, I told her, “Just rinse out the shampoo, forget the haircut, I’ll come back another time.”
I speed-dialed my husband Robert Gotkin, MD, a plastic surgeon who shares an office with me, and told him, “Please meet me at the office right away. I need to have this spot excised immediately. What if it’s a melanoma?” I shuddered to think it, because scalp melanomas are the most lethal of all melanomas.
I was terrified.
It dawned on me how utterly ironic it was. I’m a dermatologist, and Senior Vice President of The Skin Cancer Foundation, someone who regularly touts the need for monthly head-to-toe skin self-examination. In fact, I once wrote the article, “The Hows and Whys of a Total-Body Exam.” I’m a Mohs surgeon, specializing in skin cancer, operating on over 1,000 patients per year. And yet, I’d had no idea there was a potential melanoma atop my head. How could I have neglected myself? I always perform the most meticulous total-body exams on my patients — including the scalp — but how foolish I had been in failing to check my own scalp.
The truth, of course, is that when I (like you) examine myself, I can’t see my own scalp, unless I use a mirror and a blow dryer. But I had never asked anyone to look for me, like I should have.
The next three days were the longest of my life. The waiting game was unbearable as I anxiously anticipated the results of the biopsy. Finally — a call from the lab. The verdict ... “It’s benign!” The two best words you ever want to hear. It was a blue nevus, a totally benign pigmented lesion that mimics the appearance of melanoma in every way.
Overjoyed, I purchased gift certificates for the staff at the hair salon and headed straight to the salon to give thanks and praise for what they had done. Then and there, I vowed to share my experience and good fortune, and to spread the word about scalp melanoma and the important role hair stylists can play.
Scalp Melanomas: The Deadliest of All Melanomas
Melanoma is the most dangerous type of skin cancer. It is derived from melanocytes, the skin’s pigment cells, and can spread quickly (metastasize) through the lymph nodes or blood- stream if not detected at an early stage. Scalp melanomas are more lethal than other melanomas. One nationwide study found that people with scalp and neck melanomas 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 patients have skin lesions on the scalp and neck, they account for 10 percent of all melanoma deaths.2
Why are scalp melanomas more lethal? One reason may very well be a delay in diagnosis because of their location, in an area usually hidden by hair, where one cannot see them without some effort. There’s a growing belief that the biology of the melanoma itself or the environment of the scalp may play a role. The scalp is well vascularized with numerous blood vessels, and 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.3
How Can Hair Stylists Help?
Hair professionals are in a unique position to detect skin cancers on the scalp because they have a naturalview of its 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’ skin. 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.4
A Call to Action
In my opinion, a skin cancer educational program targeting hair professionals has the potential to increase the early detection of skin cancers on high-risk anatomical areas such as the scalp and neck. Far more people visit the barber or hair stylist than the dermatologist on a regular basis. Hair professionals, including those who shampoo the scalp, have a more complete view of the scalp than the rest of us do — and they can see it even more easily when the hair is wet. They spend an extended period of time with each client, often at monthly intervals. They are well- positioned to detect a scalp lesion and even to notice an early change. Hair stylists need to know that by speaking up they are not offending the client — they are potentially saving a life. Taking a photo with a client’s cell phone or pointing out the area in a mirror and encouraging the client to seek out professional advice from a dermatologist may indeed be lifesaving. Early detection and treatment usually result in the complete cure of melanoma, whereas melanomas found at an advanced stage may be curable less than 15 percent of the time.5
Deborah S. Sarnoff, MD, Clinical Professor of Dermatology at NYU School of Medicine, is in private practice in Manhattan and Long Island. She is also Senior Vice President of The Skin Cancer Foundation. Dr. Sarnoff authored Beauty and the Beam: Your Complete Guide to Cosmetic Laser Surgery, and Instant Beauty: Getting Gorgeous on Your Lunch Break (St. Martin’s Press).
- Lachiewicz AM, Berwick M, Wiggins CL, Thomas NE. Survival differences between patients with scalp or neck melanoma and those with melanoma of other sites in the Surveillance, Epidemiology, and End Results (SEER) program.Arch Dermatol2008; 144(4):515-521.
- Hareyan A. Scalp, neck melanomas most dangerous: carcinoid symptoms. EmaxHealth. http://www.emaxhealth.com/101/21814.html. April 22, 2008. Accessed Dec. 10, 2012.
- Frangou C. Scalp melanomas carry worse survival prognosis than other melanomas. General Surgery News 2012; 39(08). Accessed Dec. 10, 2012.
- Bailey EE, Marghoob AA, Orengo IF, et al. Skin cancer knowledge, attitudes, and behaviors in the salon: a survey of working hair professionals in Houston, Texas. Arch Dermatol 2011; 147(10):1159-1165.
- American Cancer Society. Cancer Facts & Figures 2013. http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-036845.pdf. Accessed Jan. 22, 2013.