June health news: Scalp and neck skin cancers are deadliest

People with melanoma on their scalps and necks are twice as likely to die from it than those who discover skin cancer on other parts of their body, according to a new study.

After reviewing 51,704 American cases of melanoma diagnosed between 1992 and 2003, scientists concluded that those with lesions on the scalp and neck have a fatality rate 1.84 times higher than those with melanoma that started on their face, ears or extremities, which have the best prognosis.

"We don't know why they are the most dangerous," says Dr. Nancy Thomas, the study's senior author, associate professor of dermatology at the University of North Carolina and member of the UNC Lineburger Comprehensive Cancer Center.

"One possibility is that the melanomas are different, they have different mutations. The other possibility is the environment they're growing in; the scalp is very vascular [rich in blood vessels], and maybe they spread more easily for that reason." The study appeared in the April issue of the journal Archives of Dermatology.

How to catch skin cancer on your neck and scalp early
Delayed diagnosis of scalp and neck skin cancers is another issue. "Our study does indicate that scalp melanomas are being diagnosed when they're thicker, which has public health implications," explains Thomas.

In fact, a recent survey by the American Society for Dermatologic Surgery found that more than 90 per cent of dermatologic surgeons had seen at least one case a year of skin cancer than went undetected.

Thomas says self-awareness is the first step to staying healthy. "Knowing what you have on your scalp, if you have some moles there, knowing if they're stable, and knowing what's new, and if something's new then having it checked out."

Make sure your physician or dermatologist looks at your scalp, which is a difficult area to check, especially if you have thick hair. And, if you've been visiting the same hairdresser or barber for years, ask them if they see something new. "Hairdressers are not trained to make diagnoses, but they can certainly tell you if something is unusual or new," says Thomas.

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Examining moles and how to detect skin cancer
Detecting possible skin cancer, particularly melanoma, can be summed up in your ABCs:
A – asymmetry
B – irregular border
C – variegation of colour
D – diameter (6 mm or more)
E – evolution or change

While analyzing moles or skin irregularities with these tips are helpful, Thomas says evolution is key. "Sometimes someone can have an early melanoma that may be a little irregular, that may not have any colour in it. So the change -- if it's new, if it's growing -- that's the kind of thing people can really pay attention to and would probably help them."

Although it's a good idea to visit a dermatologist regularly, you can work with your physician to determine if your skin is "busy" enough to warrant a second opinion. "If you just have one or two things and you know they're not changing, that's different from someone who has 100 moles and just can't keep track of them, and they already look unusual. Those individuals have to see a dermatologist regularly," explains Thomas.

Who is at the greatest risk of getting skin cancer?
Not all skin is created equal. Those who are more at risk for melanoma have:
- a personal or family history
- a lot of moles
- early life sun exposure
- sun exposure throughout life
- fair skin
- red hair
- the ability to burn easily
- inability to tan well

According to the Canadian Cancer Statistics 2008 report, produced by the Canadian Cancer Society, National Cancer Institute of Canada and Public Health Agency of Canada, there will be an estimated 4,600 new cases of and 910 deaths due to melanoma this year. Women will make up 2,100 of those new cases and 350 of those women will die from melanoma.

How can you reduce your risk of skin cancer?
You can't change what you did as a child, but you can alter your sun habits right now. "Sun exposure throughout life really does make a difference," says Thomas. Wear a hat and cover areas when outside; wear sunscreen on exposed areas, including the hairline and part; be careful during intermittent, intense sun exposure, such as on holiday, at the beach or during water-side activities. As for heading outdoors for a dose of vitamin D, people at greater risk for melanoma should boost their intake through diet and/or supplements.

And, of course, scan your skin. "Melanomas on the scalp can be quite dangerous and if you do have a new or changing growth on the scalp, have it checked out," says Thomas. "And have your scalp checked during a full skin exam."

You may not be as sun savvy as you think. Find out by taking our quiz: How sun safe are you?

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