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Skin Cancer Can Develop In Unexpected Places

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Irene Maher, Channel 8 Medical Editor

Published: October 26, 2007

It's probably the last place you would look for skin cancer. Your scalp. It never occurred to 43-year-old Karen Shultes of Palmetto. In December, she discovered a patch of discolored skin behind her left ear. She had been absent-mindedly scratching it for several weeks and finally asked her husband to take a look.

"And I lifted up my hair and he about fainted," she says. What they found looked like a stain on her scalp, dark brown to almost black in color, about the size of a quarter, with asymmetrical borders. Shultes went to her family doctor, who told her to see a dermatologist. But Shultes was in no hurry. "You think you're infallible, so you don't really take it seriously at all."

It was March before Shultes saw a dermatologist. The doctor ordered a biopsy for the next day, making it clear the procedure could not be delayed.

The bad news came a couple of days later. Shultes had stage-three melanoma skin cancer. Her doctor wanted to schedule surgery immediately, but Shultes wanted time to talk it over with her husband. "And he [the doctor] said, 'No, Karen. This is a matter of life and death. I'm putting you into Moffitt [Cancer Center] right away.'"

Melanoma is the deadliest form of skin cancer. According to the American Cancer Society, an estimated 59,940 new cases will be diagnosed this year, and 8,110 will die. Although few melanomas are found on the neck and scalp, they account for 10 percent of all melanoma deaths.

"Having a scalp melanoma almost doubles your chance of dying," says Neil Fenske, dermatologist at the University of South Florida.

Fenske has launched a campaign to enlist the help of barbers and hairdressers in the early detection of this difficult-to-find cancer. They are in a unique position to notice changes in the scalp and neck because they tend to see clients every four to six weeks. And they almost always see the scalp when it's wet, which allows them to part the hair in small sections, looking for discoloration, moles and skin changes.

"We're not trying to make them dermatologists. I don't want to even put that responsibility on their shoulders. What I'm asking them to do is point out … you've got a spot here, go see your dermatologist."

Thrisha Rom of Land O' Lakes, a hairdresser for 35 years, has always kept an eye out for scalp problems but recently became aware that she might be able to help detect skin cancer. She thinks hairdressers can play a vital role in early detection if they take a few extra minutes to check clients' scalps for changes.

"Especially over maybe a six-month period," she says, "you can see a difference in somebody. We can see a difference almost immediately."

Some melanomas look like raised moles, Fenske says, but others start out as a flat area of discoloration, as in Shultes' case. When that discoloration takes on the colors of the American flag, regardless of where it is on the body, don't waste time — see a doctor, Fenske says.

"Red, white and blue, plus black. That in particular should raise your eyebrows," he says. Other warning signs of trouble are any changes in the size, shape or color of a mole, skin growth, or birthmark; a flat, brown or black area with irregular, uneven borders and an asymmetrical shape; and a mole that becomes crusty, oozes or bleeds.

Because melanoma most often appears in hidden parts of the body, like the center of a person's back, behind a knee or the roof of the mouth, it's important to inspect your skin every month and have a formal skin cancer screening once a year, preferably performed by a physician specially trained to detect skin cancer.

Shultes had surgery in March to remove the melanoma on her scalp, as well as the lymph nodes in her neck. Her long, blonde hair now conceals the bare patch behind her left ear, which will never regrow hair. The area had to be covered by a skin graft, a large section of healthy skin harvested from her thigh. Shultes also has a long scar that stretches from the base of her left ear, down her neck, to the top of her shoulder, a result of surgery to remove lymph nodes in her neck where microscopic evidence of cancer was found.

It's been a difficult, painful journey for Shultes. One that she believes won't be in vain if just one person gets this important message: Check even the most unlikely places for skin cancer.

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