Most lethal melanomas are on scalp and neck

CHAPEL HILL – People with scalp or neck melanomas die at nearly twice the rate of people with melanoma elsewhere on the body, including the face or ears, researchers at the University of North Carolina at Chapel Hill have found.

The analysis of 51,704 melanoma cases in the U.S. confirms that survival rates differ depending on where skin cancer first appears. Those with scalp or neck melanomas die at a rate 1.84 times higher than those with melanomas on the extremities, after controlling for the possible influences of age, gender, tumor thickness and ulceration.

“Scalp and neck melanomas patients have a higher rate of death than patients with melanoma anywhere else on the body,” said Nancy Thomas, M.D., Ph.D., associate professor of dermatology in the UNC School of Medicine, a member of the UNC Lineberger Comprehensive Cancer Center and the study’s senior author. Anne Lachiewicz, a medical student in the UNC School of Medicine, is the lead author of the study.

Thomas recommends that physicians pay special attention to the scalp when examining patients for signs of skin cancer. “Only six percent of melanoma patients present with the disease on the scalp or neck, but those patients account for 10 percent of melanoma deaths. That’s why we need to take extra time to look at the scalp during full-skin examinations,” she said.

The results appear in the April issue of the journal Archives of Dermatology.

The study helps address a controversy among cancer researchers: whether scalp and neck skin cancer is more lethal primarily because it’s diagnosed later than other melanomas. “That was the thinking of a lot of people in the field,” Thomas said. But the analysis indicates that the presence of the melanoma on the scalp or neck, in itself, is an indicator of a poorer prognosis.