Scalp melanoma (SM) represents 35% of cases of head and neck melanomas and is accountable for 5% of all melanomas. Data from the literature show that SMs carry the highest mortality rates, with a 10-year survival rate of 60% which lead them to be named as the “invisible killer”.
In these areas, we have more blood vessels and many lymph nodes. Because melanoma cells can spread through the blood and lymph, it may be easier for melanoma to spread when this cancer begins in the head, neck, or scalp. For this reason, treatment tends to be more aggressive.
Similarly, the median overall survival times and 5-year overall survival rates in scalp and other sites in patients were 25.6 months and 44.1% versus 28.7 months and 62.9%, respectively (P=0.0001).
Melanoma can grow very quickly. It can become life-threatening in as little as 6 weeks and, if untreated, it can spread to other parts of the body.
It is derived from melanocytes, the skin's pigment cells, and can spread quickly through the lymph nodes or blood-stream if not detected at an early stage.
Melanoma can spread to other parts of the body, such as the lymph nodes and internal organs. This makes treatment more complicated. However, the American Academy of Dermatology (AAD) states that melanoma is highly treatable when detected early and treated properly.
Malignant skin tumours of the scalp with skull invasion, dural infiltration and brain involvement are uncommon. However, in advanced cases, skin cancer may be associated with infiltration of the skull bone and even the brain.
Late-stage melanoma - the most aggressive form of skin cancer - can spread (metastasize) through the bloodstream from its original location to the brain and other parts of the body. This occurrence is known as skin cancer metastasis, metastatic skin cancer or metastatic melanoma.
Scalp melanomas have been shown to be more lethal than other melanomas, with one study showing scalp and neck melanomas deaths were nearly twice as common compared to melanomas elsewhere on the body.
How fast does melanoma spread and grow to local lymph nodes and other organs? “Melanoma can grow extremely quickly and can become life-threatening in as little as six weeks,” noted Dr. Duncanson. “If left untreated, melanoma begins to spread, advancing its stage and worsening the prognosis.”
More than 60% of all Stage IV melanoma patients will develop brain metastases at some point, but certain factors increase the risk [1,2]: The primary tumor was on the head, neck, trunk, or abdomen. The primary tumor was ulcerated, deep, or invasive. The LDH is elevated at diagnosis of unresectable Stage III or Stage IV.
How long can you have melanoma and not know it? It depends on the type of melanoma. For example, nodular melanoma grows rapidly over a matter of weeks, while a radial melanoma can slowly spread over the span of a decade. Like a cavity, a melanoma may grow for years before producing any significant symptoms.
Superficial melanoma, also called in situ melanomas, can be removed with a surgery called a wide excision. In a wide excision, your healthcare provider will remove your melanoma and some healthy skin around it. This is to make sure all of your cancer is removed.
Nodular melanoma is the second most common melanoma, but most commonly on the head and neck. It accounts for 15 to 30% of all melanoma. There is a very aggressive (rapid vertical phase), which may present on non-sun-exposed areas (de novo). These tumors are blue-black but may lack pigment.
Melanoma of the Head and Neck Treatment
Surgical resection with wide margins and often sentinel lymph node biopsy is required for melanoma that has not spread. Thin tumors, up to 1 millimeter thick, can be resected with 1-centimeter (half an inch) margins around the tumor.
Walker, “The good news is that scalp melanoma is one of the rarest forms of this cancer, accounting for less than 5% of melanoma cases. The bad news is that scalp melanoma tends to be a more severe prognosis than other forms of melanoma.
Squamous cell cancers can metastasize to nearby lymph nodes or other organs, and can invade both small and large nerves and local structures. Biopsy can help determine if the squamous cell cancer is a low-risk tumor or a high-risk tumor that requires more aggressive treatment.
Scalp metastases can be challenging to diagnose in the early stages. Sometimes they aren't large and sometimes they get overlooked. They may appear as papule or nodules, or firm indurated plaques or ulcers or as an area closely mimicking alopecia areata. They may simply appear as an area that looks like an infection.
A large number of melanoma patients harbor neuronal autoantibodies that are associated with significant cognitive impairment affecting memory, attention, and executive function.
Stage 4 is part of the number staging system. Stage 4 is also called advanced melanoma. It means the melanoma has spread elsewhere in the body, away from where it started (the primary site) and the nearby lymph nodes.
Treating stage III melanoma
These cancers have already reached the lymph nodes when the melanoma is first diagnosed. Surgical treatment for stage III melanoma usually requires wide excision of the primary tumor as in earlier stages, along with lymph node dissection.
Stage I melanoma is no more than 1.0 millimeter thick (about the size of a sharpened pencil point), with or without an ulceration (broken skin). There is no evidence that Stage I melanoma has spread to the lymph tissues, lymph nodes, or body organs.