Skin tumours in different age groups & body areas | Part 1: The scalp

Skin tumours of the scalp can present significant diagnostic and management challenges, particularly in elderly patients. In this first part of a short series on the diagnosis and management of skin tumours in different age groups and body areas, Dr Gabriella Brancaccio explores how age, body site, and histological differentiation impact the way clinicians should approach suspicious lesions.

The scalp as a high-risk site for skin cancer, especially in bald individuals where there is little protection from UV-induced damage. While basal cell carcinoma (BCC) is the most common skin cancer overall, squamous cell carcinoma (SCC) is often the major concern on the scalp in older patients due to its potential aggressiveness and treatment complexity.

Dermoscopy can help distinguish well-differentiated from poorly differentiated SCCs. In the video, Dr Brancaccio explains how well-differentiated SCCs may show keratotic plugs, collarettes, and fine linear vessels, while poorly differentiated SCCs often appear as eroded, fleshy nodules with atypical vascular patterns and less keratin. The “whiter” the lesion, the more differentiated (and usually less aggressive) the tumour.

She also describes some of the SCC mimics, including Merkel Cell carcinoma, which can resemble undifferentiated SCC but carry very different prognoses and surgical requirements, highlighting the importance of biopsy when the diagnosis is uncertain.

Dr Brancaccio further discusses biopsy and treatment options for scalp tumours. Stay tuned next month for part two.

Watch the full video

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Dr Gabriella Brancaccio

Dr Gabriella Brancaccio is a doctor of medicine at Dermatology Unit, Università degli Studi della Campania “Luigi Vanvitelli” (University of Campania) in Naples, Italy. She is on the Executive Board of the International Dermoscopy Society as part of the Scientific Project Committee.

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