What are the most common types of scalp tumors. How can you distinguish between benign and malignant growths on the scalp. What causes skin growths to develop on the head. When should you see a doctor about a lump on your scalp.

Understanding Scalp Tumors: Definition and Prevalence

Scalp tumors are benign or malignant cutaneous lesions that arise on the scalp, which comprises the area from the back of the head to the eyebrows. These growths can occur in people of all ages and backgrounds worldwide. Interestingly, the vast majority of scalp tumors (93-99%) are benign, with only 1-2% being malignant. However, it’s crucial to note that malignant scalp tumors account for approximately 13% of all malignant cutaneous tumors, highlighting the importance of proper diagnosis and treatment.

The prevalence of different types of scalp tumors varies:

• 40-50% of benign scalp tumors are cysts, with an estimated 20% incidence in Western populations
• Trichilemmal (or pilar) cysts are particularly common, with 80% occurring on the scalp
• Lipomas account for about 30% of benign scalp tumors
• Melanocytic nevi make up approximately 28% of benign scalp tumors
• Seborrheic keratoses and actinic keratoses become more common with age, especially as hair thins

Among malignant scalp tumors, the most common types include:

1. Basal cell carcinoma (approximately 41%)
2. Squamous cell carcinoma (about 17%)
3. Cutaneous metastases
4. Adnexal tumors
5. Angiosarcomas
6. Lymphomas

Causes and Risk Factors for Scalp Tumors

The development of scalp tumors can be attributed to various factors, depending on the underlying tissue of origin and associated comorbidities. These growths can arise from cells in both the skin (epidermis and dermis) and deeper tissue layers. In some cases, they may even originate from other cells in the body due to metastases.

Some common risk factors for developing scalp tumors include:

• Prolonged sun exposure, particularly for basal cell and squamous cell carcinomas
• Genetic predisposition, such as in cases of familial syndromes
• Immunosuppression, which can increase the risk of certain skin cancers
• Age, as the likelihood of developing certain growths increases with time
• Previous radiation exposure to the scalp area
• Chronic inflammation or irritation of the scalp

Clinical Features of Benign Scalp Tumors

Benign scalp tumors can present with a wide range of clinical features, depending on their cellular origin and specific type. Understanding these characteristics can help in identifying and differentiating between various benign growths:

Epidermoid Cysts

Epidermoid cysts are derived from keratinocytes and typically appear as firm, flesh-colored or yellow papules or nodules. A distinctive feature is the presence of a central punctum that may exude foul-smelling debris. These cysts are generally harmless but can become inflamed or infected if ruptured.

Dermoid Cysts

Dermoid cysts present as firm, dough-like lumps consisting of epidermal and dermal tissue components. They are often congenital and can be found along embryonic fusion lines. Unlike epidermoid cysts, dermoid cysts may contain various tissue types, including hair follicles and sebaceous glands.

Seborrheic Keratosis

Seborrheic keratoses are common benign growths that appear as flat or raised lesions with a “stuck-on” appearance. They can vary in color and size and are most commonly seen in adults over 60 years of age. These growths are typically harmless but can sometimes be mistaken for more serious skin conditions.

Melanocytic Nevi

Melanocytic nevi, commonly known as moles, are localized proliferations of melanocytes. They can be flat or raised and vary in color from light brown to black. It’s worth noting that scalp variants of melanocytic nevi have a higher propensity to display dysplastic histological features, warranting closer monitoring.

Blue Nevi

Blue nevi are characterized by a flat or raised localized proliferation of spindle-shaped or ovoid nevus cells in the dermis. As the name suggests, they often have a blue or blue-gray appearance due to the Tyndall effect, where light is scattered by dermal melanin.

Trichilemmal Cysts

Trichilemmal cysts, also known as pilar cysts, are keratin-filled nodules derived from the outer hair root sheath. Unlike epidermoid cysts, they lack a central punctum. These cysts are typically smooth, round, and mobile, and are most commonly found on the scalp. In rare cases, they may develop into benign proliferating trichilemmal tumors.

Identifying Malignant Scalp Tumors

While less common than benign growths, malignant scalp tumors require prompt identification and treatment. Here are some key features of common malignant scalp tumors:

Basal Cell Carcinoma (BCC)

BCC is the most common type of malignant scalp tumor, accounting for approximately 41% of cases. It typically presents as a pearly, flesh-colored nodule or a pinkish patch of skin. BCCs may also appear as a scar-like area or an open sore that doesn’t heal. They tend to grow slowly and rarely metastasize, but can cause significant local destruction if left untreated.

Squamous Cell Carcinoma (SCC)

SCC is the second most common malignant scalp tumor, representing about 17% of cases. It often appears as a firm, red nodule or a flat lesion with a scaly, crusted surface. SCCs can grow quickly and may be tender to the touch. They have a higher risk of metastasis compared to BCCs, especially when located on the scalp.

Melanoma

Although less common than BCC and SCC, melanoma is the most aggressive form of skin cancer. On the scalp, it may present as a new, unusual growth or a change in an existing mole. The “ABCDE” rule can help identify potential melanomas:

• A – Asymmetry
• B – Border irregularity
• C – Color variation
• D – Diameter greater than 6mm
• E – Evolution or change over time

Cutaneous Metastases

These are secondary tumors that have spread to the scalp from primary cancers elsewhere in the body. They can present as firm, painless nodules or as diffuse thickening of the scalp. The appearance may vary depending on the origin of the primary tumor.

Diagnostic Approaches for Scalp Tumors

Accurate diagnosis of scalp tumors is crucial for determining the appropriate treatment plan. Healthcare providers typically employ a combination of clinical examination and diagnostic techniques to identify and characterize scalp growths:

Clinical Examination

A thorough visual inspection and palpation of the scalp are the first steps in diagnosing scalp tumors. Dermatologists look for specific features such as color, shape, size, and texture of the growth. They may also use a dermatoscope, a handheld device that provides magnified views of skin lesions, to examine the tumor in more detail.

Biopsy

A biopsy is often necessary to confirm the diagnosis and determine whether a growth is benign or malignant. There are several types of biopsies that may be performed:

• Shave biopsy: Removes a thin layer of the tumor
• Punch biopsy: Takes a small, cylindrical sample of the tumor
• Excisional biopsy: Removes the entire tumor along with a margin of healthy tissue

The biopsy sample is then examined under a microscope by a pathologist to determine the tumor’s characteristics and classification.

Imaging Studies

In some cases, imaging studies may be necessary to assess the extent of the tumor and its potential involvement of deeper structures. Common imaging techniques include:

• Ultrasound: Useful for evaluating the depth and extent of superficial tumors
• CT scan: Provides detailed images of the scalp and underlying structures
• MRI: Offers high-resolution images and is particularly useful for soft tissue tumors

Blood Tests

While not typically used for diagnosis, blood tests may be ordered to assess overall health or to look for specific markers in cases of suspected systemic involvement or metastatic disease.

Treatment Options for Scalp Tumors

The treatment of scalp tumors depends on various factors, including the type of tumor, its size, location, and whether it is benign or malignant. Here are some common treatment approaches:

Surgical Excision

Surgical removal is the most common treatment for both benign and malignant scalp tumors. The procedure involves removing the entire tumor along with a margin of healthy tissue to ensure complete removal. For malignant tumors, wider margins may be necessary to reduce the risk of recurrence.

Mohs Micrographic Surgery

This specialized surgical technique is often used for certain types of skin cancer, particularly basal cell and squamous cell carcinomas. Mohs surgery involves removing thin layers of cancer-containing skin and examining them under a microscope until all cancer cells have been removed. This method preserves as much healthy tissue as possible while ensuring complete tumor removal.

Radiation Therapy

Radiation therapy may be used for certain malignant scalp tumors, particularly in cases where surgery is not feasible or as an adjuvant treatment following surgery. It can also be employed for palliative care in advanced cases.

Chemotherapy

Systemic chemotherapy may be necessary for advanced or metastatic skin cancers. In some cases, topical chemotherapy agents can be used for superficial skin cancers or precancerous lesions.

Immunotherapy

Immunotherapy drugs, which help the body’s immune system recognize and attack cancer cells, have shown promise in treating certain types of advanced skin cancers, including melanoma.

Cryotherapy

This treatment involves freezing the tumor with liquid nitrogen and is sometimes used for small, superficial skin cancers or precancerous lesions.

Photodynamic Therapy

This treatment combines light-sensitive drugs with a specific type of light to destroy cancer cells. It can be effective for certain superficial skin cancers and precancerous growths.

Prevention and Scalp Health Maintenance

While not all scalp tumors can be prevented, there are several steps individuals can take to reduce their risk and maintain overall scalp health:

Sun Protection

Protecting the scalp from excessive sun exposure is crucial in preventing skin damage and reducing the risk of skin cancer. This is particularly important for individuals with thinning hair or bald spots. Strategies for sun protection include:

• Wearing wide-brimmed hats or caps when outdoors
• Applying sunscreen to exposed areas of the scalp
• Seeking shade during peak sunlight hours (typically 10 am to 4 pm)

Regular Self-Examinations

Performing regular self-examinations of the scalp can help detect any new or changing growths early. Use a handheld mirror or ask a partner to help examine areas that are difficult to see. Look for any unusual bumps, changes in moles, or areas of concern.

Professional Skin Checks

Schedule regular skin checks with a dermatologist, especially if you have a history of skin cancer or are at high risk. These professionals can thoroughly examine your scalp and identify any suspicious growths that may require further investigation.

Maintain Scalp Hygiene

Keeping the scalp clean and healthy can help prevent certain types of infections and inflammations that might contribute to the development of benign growths. Use gentle, pH-balanced shampoos and avoid excessive use of harsh chemicals or heat styling tools.

Healthy Lifestyle Choices

Maintaining overall health can contribute to scalp health. This includes:

• Eating a balanced diet rich in antioxidants
• Staying hydrated
• Managing stress levels
• Avoiding smoking and excessive alcohol consumption

Prompt Attention to Scalp Issues

If you notice any unusual changes in your scalp, such as persistent itching, scaling, or the appearance of new growths, seek medical attention promptly. Early intervention can often lead to better outcomes, especially in cases of potentially malignant tumors.

When to Seek Medical Attention

While many scalp tumors are benign and may not require immediate medical intervention, it’s important to know when to consult a healthcare professional. Here are some signs that warrant medical attention:

• A new growth on the scalp that persists for more than a few weeks
• Changes in the size, shape, or color of an existing mole or growth
• Any lesion that bleeds, oozes, or doesn’t heal
• Persistent itching, pain, or tenderness in a specific area of the scalp
• Unexplained hair loss associated with a scalp lesion
• Any growth that rapidly increases in size
• A family history of skin cancer, especially if you notice unusual scalp growths

Remember, early detection and treatment of scalp tumors, especially malignant ones, can significantly improve outcomes and reduce the risk of complications. When in doubt, it’s always better to consult a dermatologist or healthcare provider for a professional evaluation.

Understanding scalp tumors, their causes, and potential treatments is crucial for maintaining scalp health and overall well-being. By staying informed, practicing prevention strategies, and seeking timely medical care when necessary, individuals can effectively manage their scalp health and address any concerns that may arise. As research in dermatology and oncology continues to advance, new diagnostic tools and treatment options are likely to emerge, further improving the management of scalp tumors and enhancing patient outcomes.

Scalp Tumours and Cysts: A Complete Overview

Authors: Rajan Ramji, Clinical Medical Education Fellow, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; Jenny Chung, Dermatology Registrar, Middlemore Hospital, Auckland, New Zealand. Copy edited by Gus Mitchell. February 2022

toc-icon

What are scalp tumours?

The scalp comprises the area from the back of the head (beginning at the superior nuchal lines) to the eyebrows (supraorbital margin). Scalp tumours are benign or malignant cutaneous lesions which arise on the scalp.

Scalp tumours

Pilar scalp cysts

An ulcerated atypical fibroxanthoma on a bald scalp

Giant neglected basal cell carcinoma ulcerated down to the skull

Sclap and forehead tumour due to B cell lymphoma

Superficial spreading malignant melanoma on the scalp with recent development of nodular component

Angiosarcoma

Who gets scalp tumours?

Scalp tumours occur worldwide. Most scalp tumours (93–99%) are benign as opposed to malignant.

Approximately 40–50% of benign scalp tumours are cysts with an estimated 20% incidence in Western populations. Trichilemmal (or pilar) cysts are especially common and it is estimated 80% of these cysts occur on the scalp. The remaining proportion of benign scalp tumours primarily comprises lipomas (~30%) and melanocytic naevi (28%). Seborrhoeic keratoses and actinic keratoses are increasingly common with age and the latter develop particularly as the hair thins.

Although only 1–2% of scalp tumours are malignant, they comprise approximately 13% of malignant cutaneous tumours. The most common (in decreasing order of commonality) malignant scalp tumours include basal cell carcinoma (~41%), squamous cell carcinoma (~17%), cutaneous metastases, adnexal tumours, angiosarcomas, and lymphomas.

What causes scalp tumours?

The causes of both benign and malignant scalp tumours are varied and can depend on the underlying tissue of origin and associated co-morbidities. Scalp tumours can arise from cells in both the skin (epidermis and dermis) and deeper tissue layers. It may also originate from other cells in the body due to metastases.

What are the clinical features of scalp tumours? 

Both benign and malignant scalp tumours can occur elsewhere on the body but may have different physical features. The exact features displayed are dependent on the originating site and cells of the tumour, summarised in Table 1 and 2.

Table 1. Benign scalp tumours

Epidermoid cyst	Keratinocytes	Firm, flesh-coloured or yellow papules/nodules which may have a central punctum that exudes foul smelling debris.
Dermoid cyst		Firm dough-like lumps consisting of epidermal/dermal tissue components.
Seborrhoeic keratosis		Flat or raised lesions with a stuck-on appearance, variable coloration and diameter. Commonly seen in adults over 60 years of age.
Melanocytic naevus	Melanocytes	Flat or raised localized proliferation of melanocytes. Higher propensity for scalp variants to display dysplastic histological features.
Blue naevus		Flat or raised localized proliferation of spindle shaped or ovoid naevus cells in the dermis.
Trichilemmal cyst	Hair follicles	Keratin filled nodules derived from the outer hair root sheath and lacking a central punctum. Rarely develops into benign proliferating trichilemmal tumours although this occurs more commonly on the scalp — especially in older women.
Pilomatricoma		Skin coloured or purplish irregular papules derived from hair matrix cells which commonly become hard and bony due to calcification.
Sebaceoma	Sebaceous glands	Sebaceous cell proliferations that manifest as skin coloured or yellow nodules originating from deeper in the skin than sebaceous adenomas.
Sebaceous adenoma		A more superficially located form of sebaceomas manifesting as skin coloured or yellow papules or nodules.
Hidrocystoma	Apocrine/eccrine glands	Apocrine or eccrine derived skin coloured or blue cysts which may arise as solitary multiple lesions. Typically seen on the scalp or face – particularly the eyelid margins (Moll gland cysts).
Syringoma		Firm skin coloured or yellow papules millimetres in diameter and commonly occurring in clusters.
Eccrine poroma		Papules, plaques, or nodules derived from the epithelial terminal duct which histologically differentiate into poroid (glandular duct) cells.
Lipoma	Adipocytes	Smooth round collection of subcutaneous fat with a rubbery texture to palpation.
Infantile haemangioma	Vascular	Bright red, blue or flesh-coloured, non-tender and non-pulsatile papules/plaques representing a vascular malformation in the dermis or subcutaneous tissue.
Cavernous haemangioma		Infantile haemangiomas representing vascular malformations in the lower dermis or subcutaneous tissue.
Venous malformation		Skin coloured, blue or purple swellings of variable size that represent malformed veins and are a form of vascular naevi.
Lymphangioma	Lymphatic	Malformed lymph ducts of variable size that are a form of vascular naevi and most prominent in infancy or childhood
Leiomyoma	Myocytes	Proliferations of myocytes which can develop from both smooth and skeletal muscle. Typically present as firm, smooth, and tender hyperpigmented or red-brown nodules.
Dermatofibroma	Collagen(fibrous)/histiocytes	Solitary, firm papules or nodules of variable coloration that may dimple on pinching.
Hypertrophic scar		A growth of fibrous tissue that develops as part of wound healing processes. Typically begins as red and prominent before becoming flat and pale.
Keloid scar		Firm smooth fibrous tissue that characteristically extends beyond the site of the precipitating injury.
Infantile myofibromatosis		Firm or rubbery circular nodules formed from the proliferation of myofibroblasts in the dermis or subcutaneous tissue.
Neurofibroma	Neural	Well circumscribed soft or firm growths derived from Schwann cells, fibroblasts, mast cells, and vascular components of underlying nerves. Occurs in association with Café-au-lait macules in Neurofibromatosis 1 (NF1).
Schwannoma		Smooth, soft, and solitary skin-coloured or yellow papules or nodules originating in the dermis or subcutaneous tissue and derived from Schwann cells forming the myelin sheath of nerves.
Langerhans cell histiocytosis	Haematologic	Overactive accumulation of Langerhans cells in the epidermis with a spectrum of clinical manifestations typically seen in childhood or adolescence. May appear as pink or reddish-brown papules, pustules, vesicles, or blisters with crusting, scale, or impetiginisation.
Rosai-Dorfman disease		Unprovoked histiocyte proliferation disorder characterized by massive cervical lymphadenopathy. Less than 10% of cases may manifest with multiple macules, papules, nodules, and plaques of red, red-brown or yellow coloration.
Juvenile xanthogranuloma		A non-Langerhans cell histiocytosis that typically manifests as domed red-brown or yellow papules or nodules in children or adolescents. Typically manifests in skin but may also develop in eyes or internal organs.

Table 2. Malignant scalp tumours

Squamous cell carcinoma	Keratinocytes	A malignant proliferation of keratin producing cells extending beyond the epidermis. Scalp variants more frequently present with ulceration and have a higher propensity for recurrence.
Intraepidermal squamous cell carcinoma		Also known as Bowen’s disease. A malignant proliferation of keratin producing cells localized within the epidermis.
Basal cell carcinoma		A malignant proliferation of keratin producing cells extending beyond the epidermis. Scalp variants more frequently present with ulceration and have a higher propensity for recurrence. Pigmented or nodular subtypes are also more commonly seen and are more likely to demonstrate a melanocytic pattern on dermoscopy.
Keratoacanthoma		Rapidly growing firm circular nodule with a keratin core. A variant of squamous cell carcinoma.
Malignant melanoma	Melanocytes	Indistinct presentation of variously pigmented or nonpigmented lesions derived from a malignant proliferation of melanocytes. Scalp melanomas are more commonly seen in older men and are associated with alopecia. Compared to other body areas, there may be a higher propensity to present as recurrent desmoplastic or amelanotic melanoma. Lesions are also more likely to develop ulceration and have a greater Breslow thickness.
Malignant proliferating trichilemmal tumour	Hair follicles	Keratinized nodules or cysts derived from outer hair root sheath cells with low potential for metastasis. May develop from trichilemmal cysts.
Pilomatrix carcinoma		A low grade adnexal carcinoma derived from hair matrix cells that may manifest as skin coloured or purplish irregular papules.
Sebaceous carcinoma	Sebaceous glands	A form of adnexal carcinoma where the cells demonstrate a differentiation into sebaceous cells. Lesions lack distinguishing features but may appear as yellow nodules or plaques with ulceration or crusting.
Apocrine carcinoma	Sweat glands	An adenocarcinoma derived from apocrine glands. Lesions may manifest as ulcerating or bleeding nodules but otherwise have an indistinct presentation and are usually diagnosed histologically.
Porocarcinoma		An adenocarcinoma derived from eccrine (sweat) glands. As with apocrine carcinomas, lesions have a nondescript appearance but may appear as ulcerating or bleeding nodules that are diagnosed histologically.
Atypical lipomatous tumour	Adipocytes	Malignant proliferation of adipocytes that rarely develops in the skin but can resemble an enlarging lipoma. Differentiated from liposarcoma on the basis of histology findings.
Liposarcoma		Malignant proliferation of adipocytes that can present identically to an atypical lipomatous tumour or an enlarging lipoma.
Angiosarcoma	Vascular	Aggressive tumours that uncommonly develop from endothelial cells in blood (haemangiosarcoma) or lymphathic (lymphangiosarcoma) vessels May manifest as painful rapidly growing bruises, blue-black nodules, or persistent ulcers.
Leiomyosarcoma	Myocytes	Malignant proliferation of smooth muscle cells that may also develop in the dermis or subcutaneous tissue.
Dermatofibrosarcoma protuberans	Collagen(fibrous)/histiocytes	Slow growing tumours derived from collagen that develop in the dermis. Typically manifests as red-brown to skin coloured painless lichenified plaques or fixed, firm nodules.
Fibrosarcoma		Malignant proliferation of spindled fibroblasts or myofibroblasts which are typically firm and spherical but otherwise nondescript in appearance. Generally carries a poor prognosis.
Merkel cell carcinoma	Neural	Aggressive tumours with high metastatic potential, thought to be derived from pressure receptors (Merkel cells) in the skin. Approximately 80% of cases are found to have concomitant Merkel cell polyomavirus. The most common site of development is the head and neck region. Scalp lesions are typically larger and have an even higher risk of metastasis.
Malignant peripheral nerve sheath tumour		Proliferations of one or more types of cells that compose peripheral nerve sheaths – typically originate from perineural or endoneurial fibroblasts. Associated with plexiform neurofibromas.
Lymphoma	Haematologic	A malignant proliferation of lymphocytes. Multiple cutaneous and non-cutaneous variants exist. The most commonly occurring variants on the scalp include primary cutaneous follicle centre and/or marginal zone lymphomas.
Metastases	Various	Secondary malignant proliferations that develop from the spread of a primary malignancy beyond its site of origin. The scalp can both develop malignancies which metastasize and act as a site for metastases from other body sites. Metastases commonly associated with the scalp include: Melanoma Papillary thyroid carcinoma Breast cancer Pulmonary adenocarcinoma Colorectal adenocarcinoma Hepatocellular carcinoma Cholangiocarcinoma Renal cell carcinoma Langerhans cell histiocytosis

How are scalp tumours diagnosed?

Some scalp tumours may be diagnosed through a clinical examination alone. A biopsy or radiologic workup may be necessary to confirm the diagnosis.

What are the treatments for scalp tumours?

Treatment options are dependent on the nature of the tumour, anatomical location, and underlying diagnosis. Given that malignant scalp tumours carry a worse prognosis than lesions in other anatomic areas, radical surgical excision is more likely to be recommended. Excision can be complicated by the relative lack of scalp skin mobility. Mohs micrographic surgery may be a preferable option in these cases.

Other treatments may include:

• Cryotherapy
• Electrodessication and curettage
• Photodynamic therapy
• Topical therapy (i.e. 5% imiquimod)
• Radiotherapy.

What is the outcome for scalp tumours?

Malignant scalp tumours tend to carry a worse prognosis than equivalent tumours elsewhere on the body. The exact prognosis is dependent on the specific tumour involved and the degree of invasion beyond the skin. Scalp metastases (either originating from scalp tumours or elsewhere) typically carry a poor prognosis.

References

• Augsburger D, Nelson PJ, Kalinski T, Udelnow A, Knösel T, Hofstetter M, et al. Current diagnostics and treatment of fibrosarcoma –perspectives for future therapeutic targets and strategies. Oncotarget. 2017 Aug 10;8(61):104638–53. PubMed
• Dika E, Patrizi A, Veronesi G, Manuelpillai N, Lambertini M. Malignant cutaneous tumours of the scalp: always remember to examine the head. J Eur Acad Dermatol Venereol. 2020;34(10):2208–15. PubMed
• Kawaguchi M, Kato H, Matsuo M. CT and MRI features of scalp lesions. Radiol Med (Torino). 2019 Oct 1;124(10):1049–61. PubMed
• Prodinger CM, Koller J, Laimer M. Scalp tumors. JDDG J Dtsch Dermatol Ges. 2018;16(6):730–53. PubMed
• Xie C, Pan Y, McLean C, Mar V, Wolfe R, Kelly JW. Scalp melanoma: Distinctive high risk clinical and histological features. Australas J Dermatol. 2017;58(3):181–8. PubMed

On DermNet

• Epidermoid cyst
• Dermoid cyst
• Seborrhoeic keratosis
• Melanocytic naevus
• Blue naevus
• Trichilemmal cyst
• Pilomatricoma
• Syringoma
• Venous malformation
• Lymphatic malformation
• Leiomyoma
• Neurofibromatosis
• Juvenile xanthogranuloma
• Merkel cell carcinoma

Books about skin diseases

• Books about the skin
• Dermatology Made Easy book

Seborrheic keratosis: Symptoms, treatment, and causes

Seborrheic keratoses are common, harmless, noncancerous growths on the skin. They usually appear as tan, brown, yellow, gray, or very dark brown warty growths ‘stuck onto’ the back, shoulders, chest, or face.

Also known as basal cell papilloma or seborrheic warts, seborrheic keratoses can appear anywhere on the skin except the palms, soles, and mucous membranes. They often appear on the scalp, trunk, neck, arms, and legs and sometimes occur on the face. Some look black but are, in fact, very dark brown.

Seborrheic keratoses can look like warts but are different from warts. Warts result from a virus, such as the human papillomavirus (HPV). Seborrheic keratoses are unlikely to stem from HPV or another virus, according to Dermnet NZ. They are not contagious.

Seborrheic keratoses tend to appear from middle age onwards. Some individuals may have just one, but there will usually be several. Seborrheic keratosis is not contagious.

Over 80 million people in the United States have seborrheic keratoses. They can occur at any age but are most common after the age of 50 years.

Seborrheic keratoses may look like warts, moles, or skin cancer.

They can have the following features:

• Color: Tan, brown, yellow, gray, or skin-colored; some are very dark brown but may appear black.
• Location: Commonly on the trunk, scalp, trunk, neck, limbs, and sometimes the face. They do not affect the soles of the feet or palms of the hands.
• Texture: Can be “waxy” in appearance or rough and crusty, like a barnacle.
• Raised or not: Can look as if “stuck onto” the skin, but some are flat.
• Size: From a pinpoint to over 1 inch (around 2 millimeters to 3 centimeters) across.
• Shape: Usually round or oval.
• Sensation: Not painful but may itch or become irritated.
• Number: Ranging from one to hundreds of lesions.
• Growth: Lesions usually start as small, rough bumps and gradually get thicker and develop a warty surface. They grow slowly.

Some lesions can be light-colored and flat, like a solar lentigo, which is also known as a sunspot or “liver” spot.

On darker skin, seborrheic keratoses present similarly but are more likely to be the darker brown type.

Seborrheic keratosis lesions are rarely painful but can be annoying, depending on their position. It is important not to pick or scratch them as this can lead to bleeding, swelling, and potentially, infection.

There are many types and subtypes of seborrheic keratoses, including stucco keratoses and dermatosis papulosa nigra.

Stucco keratoses are multiple small, light tan papules or bumps with a rough texture, specifically around the lower legs and ankles.

Dermatosis papulosa nigra appears as multiple small, dark pigmented papules or bumps. Lesions often appear on the face. They tend to affect people with brown or black skin.

It can be difficult to distinguish between seborrheic keratoses and skin cancer lesions. For this reason, anyone who notices new lesions or skin changes should see a doctor.

If they already have a diagnosis, they should request an appointment if the following occur:

• a large number of growths grow in a short space of time
• the borders around the growths are irregular or blurred
• the growths are irritated by clothes and regularly bleed, as removal may be an option
• growths or sores develop and do not heal
• the growths are an unusual color, for instance, purple, reddish-black, or blue
• there is itching or irritation

People with multiple seborrheic keratoses may wish to make a yearly appointment with a dermatologist to check for changes that could be cancerous.

How do you know if a lesion is cancerous?

In most cases of seborrheic keratosis, no further treatment is necessary.

However, a doctor may recommend removing the growth in the following cases:

• It is hard to distinguish from skin cancer or the diagnosis is uncertain.
• The individual does not like it and wants to remove it.
• It causes itching or irritation, or clothing and jewelry rub against it.

If the dermatologist carries out a biopsy, they will usually remove the seborrheic keratosis at the same time.

There are several ways to remove seborrheic keratoses.

Cryosurgery

A doctor applies liquid nitrogen to the growth with a spray gun or cotton swab. The lesion freezes and falls off in a few days. A blister may form that will eventually dry into a crust and fall off.

However, the lesion can grow back, and changes in pigmentation can also occur.

How can cryosurgery treat a wart?

Skin shaving (shave excision)

A doctor shaves off the lesion with a scalpel without touching the layers beneath the skin’s surface. The collected cells can then go to a laboratory for a biopsy.

Electrocautery, curettage, or both

In electrocautery — also known as electrosurgery — the surgeon uses an electric current to burn (cauterize) the growth, under a local anesthetic. In curettage, a doctor uses a curette — a scoop-shaped surgical instrument — to scrape off the burnt growth.

A doctor will usually apply a local anesthetic to numb the area. On the face, however, they will use a lower current and will not numb the area.

Some people need only electrocautery, some need curettage, and others need both.

Laser therapy

The doctor uses a laser to remove the lesion.

Laser treatment can be ablative or nonablative. Ablative surgery removes the top layer of skin and heats the underlying layer to stimulate the growth of new collagen fibers. Nonablative surgery is less invasive and works by stimulating the growth of new collagen.

Topical treatments

Researchers are currently looking into options for topical applications to remove seborrheic keratoses.

The Food and Drug Administration (FDA) has approved a 40% hydrogen peroxide solution for raised keratoses that appears safe and effective. Minor adverse effects may occur, such as scaling, inflammation, and changes in skin color.

Chemical peels are also available. A doctor applies a peel containing trichloracetic acid to the lesion.

All these methods have disadvantages, such as:

• irritation and discomfort in the area during recovery time
• changes in pigmentation, where the skin becomes lighter or darker
• the need for several sessions, as a doctor may be unable to remove all lesions in one intervention.
• recurrence of growths or lesions continue to appear in other areas

There are no proven home remedies for seborrheic keratoses.

Lemon juice or vinegar can irritate the skin, possibly causing the lesion to dry and crumble. However, there is no evidence that this is safe or effective.

Some substances, such as tea tree oil, can trigger allergic contact dermatitis, an immune system reaction that causes itching and inflammation around the site.

Anyone with concerns about a lesion should see a doctor, who can check that it is not melanoma and advise on treatment, if appropriate.

Dermatologists are not certain why seborrheic keratoses develop.

Possible causes and risk factors include:

• Skin damage: Some types of seborrheic keratoses appear after dermatitis or sunburn.
• Genetic factors: Scientists believe a genetic mutation could be responsible when people develop a high number of seborrheic keratoses or when they run in families.
• Age: They are more common in those aged 50 years or above.
• Exposure to ultraviolet (UV) light: Similarities with solar lentigo suggest UV light may play a role.
• Medication: People who use epidermal growth factor receptor inhibitors to treat cancer may have a higher risk of warty growths.
• Skin friction: This may increase the risk and explain why they often appear in skin folds.

Seborrheic keratoses do not appear to be linked to any viral infection.

The authors of a 2016 research article note that seborrheic keratoses have “virtually no malignant potential.”

In rare cases, however, a sudden onset of numerous seborrheic keratoses may be linked to underlying malignancy, such as cancer in the gastrointestinal tract, lymphoma, or leukemia. In this case, it is known as Leser-Treélat sign.

Sudden eruptions of numerous seborrheic keratoses can also occur in pregnancy, during chemotherapy, and with various inflammatory skin disorders.

To diagnose seborrheic keratosis, a physician or dermatologist:

• will ask about symptoms and family and medical history
• will carry out a visual and physical examination
• may recommend a biopsy to rule out skin cancer and remove a growth at the same time
• may recommend further tests to rule out other conditions

A lesion with the features of seborrheic keratosis is unlikely to be skin cancer.

However, since it can be hard to distinguish between skin cancer and seborrheic keratoses, it is best to check with a doctor, especially if multiple lesions appear in a short time or if lesions change.

If the doctor suspects melanoma or is unsure, they may recommend a biopsy for examination under a microscope.

Seborrheic keratoses rarely become cancerous, but they share genetic features with some types of cancer. Researchers believe the gene process used by the lesions could help scientists learn more about certain types of cancer.

Here are some answers to questions people often ask about seborrheic keratoses.

How do you get rid of seborrheic keratoses?

In most cases, seborrheic keratoses do not need treatment, but a person may opt to remove them if they snag on clothing or feel unsightly. A doctor may remove one while taking a biopsy for skin cancer. Options include minor surgery, laser therapy, and cryotherapy. A doctor can advise on the best approach.

What do seborrheic keratoses look like?

Seborrheic keratoses can be skin-colored, tan, brown, yellow, gray, or very dark brown that may appear black. They can look waxy or rough, like a wart. Some are raised, as if stuck onto the skin, while others are flat. The size can range from a pinpoint to over 1 inch (around 2 millimeters to 3 centimeters) across. They usually grow slowly.

Are seborrheic keratoses serious?

Seborrheic keratoses are not cancerous but can share some features with malignant lesions. They can be hard to tell apart from skin cancer, so it is essential to see a doctor about any new or unexplained lesions.

Seborrheic keratoses are harmless lesions that appear on the skin, especially as people get older. They can occur anywhere on the body except the soles of the feet and palms of the hands.

They may be yellow, brown, tan, or skin-colored. Some look black but are, in fact, dark brown. They may be raised as if stuck onto the skin, but some are flat.

It can be hard to tell the difference between seborrheic keratoses and skin cancer. For this reason, a person should see a doctor if they notice a new lesion or if a lesion changes in any way.

Stimulation of hair growth on the head in women and men: effective procedures in CosmetoMed

#clinic_kosmetomed

Stimulation of hair growth is an important aspect of hair care, especially for those who experience hair loss or stunted growth. In this text, we will look at various procedures and methods that contribute to the stimulation of hair growth.

• Laser Hair Growth Stimulation: Laser therapy is one of the effective methods of hair growth stimulation. This is a safe and painless procedure in which laser radiation penetrates the scalp, stimulating blood circulation and providing sufficient nutrition to the hair follicles. It helps to accelerate the growth of new hair and strengthen existing ones.
• Mesotherapy: Mesotherapy is a procedure in which special preparations containing nutrients and vitamins are injected into the scalp. This improves the nutrition of the hair follicles and stimulates the growth of new hair. Mesotherapy can be carried out both by injection and using special devices that ensure the delivery of nutrients in a painless way.
• Salon treatments: Beauty salons offer a range of treatments to help stimulate hair growth. It can be a head massage, acupuncture, darsonvalization or glycolic peeling of the scalp. These procedures improve blood circulation, stimulate hair follicles and promote their growth.
• In-Salon Treatments and Treatments: It is important to choose quality products that promote hair growth. These can be shampoos, conditioners, masks or serums containing active ingredients such as peptides, vitamins, plant extracts and minerals. Additionally, beauty salons offer treatments such as ozone therapy, cryomassage and darsonvalization, which help stimulate hair growth.
• Proper nutrition and a healthy lifestyle: Don’t forget the importance of proper nutrition and a healthy lifestyle to stimulate hair growth. Regular consumption of nutritious foods such as vegetables, fruits, nuts, fish, and eggs provides an adequate supply of the vitamins and minerals needed for healthy hair. It’s also important to stay active, exercise regularly, manage stress levels, and get enough sleep.

Do not forget that hair growth stimulation is an individual process, and its effectiveness may vary depending on the characteristics of the body. Before using any procedure or product, it is recommended to consult a doctor or specialist to receive personalized advice and recommendations.

CALL US +7 (495) 500 00 97 or +7 (910) 455 34 97

1. Consultation with a trichologist and trichoscopic hair examination

   3000
   rub

2. Phototrichogram

   2400
   rub

3. Trichoscopy

   1200
   rub

4. Plasma therapy of the scalp

   5400
   rub

5. Intradermal injection of drugs into the scalp with microelements, vitamins, etc. 2.5 ml

   2760
   rub

6. Mesotherapy of the scalp “Filorga NCTF 135” 1.5 ml

   4950
   rub

7. Mesotherapy of the scalp “Filorga NCTF 135” 3.0 ml

   6930
   rub

8. Scalp mesotherapy “HyalCode Zn” 1. 0% – 2.5 ml

   3960
   rub

9. Mesotherapy of the scalp “HyalCode Zn” 1.0% – 5.0 ml

   7700
   rub

10. Viscoderm Skinko scalp mesotherapy 2.5ml

    3750
    rub

11. Viscoderm Skinko scalp mesotherapy 5. 0 ml

    7150
    rub

12. Mesotherapy of the scalp with hyaluronic acid “Hydro line” 2.0 ml

    2800
    rub

13. Scalp mesotherapy – for sparse and thin hair – “Hair System” Mesotech 5.0 ml

    4510
    rub

14. Scalp mesotherapy with vitamins and HairXpeptid peptide complex 2. 0 ml

    4500
    rub

15. Mesotherapy of the scalp with vitamins “HairXVita Line B+” 1.0 ml

    2880
    rub

16. Intradermal injection of Kenalog into the affected area 1.0 ml

    3000
    rub

17. Intradermal injection of Lidaza/Longidase into the affected area 1. 0 ml

    3000
    rub

18. Fractional mesotherapy of the scalp (excluding the cost of the drug)

    600
    rub

19. Erbium laser treatment of the scalp (Photon)

    3600
    rub

20. Carboxytherapy – injection of CO2 into the scalp

    2000
    rub

Expert of the article you are reading:

ZHANNA MIRONOVA

Dermatovenerologist, cosmetologist of the highest category

Mironova Zh. M. dermatovenereologist, cosmetologist. Work experience more than 20 years.
Since 2017, she has been working in the Department of Aesthetic Medicine of the National Research Center for Endocrinology of the Ministry of Health of the Russian Federation. Professionally owns laser, injection and thread methods of appearance correction. Successfully engaged in the diagnosis and removal of benign skin tumors. Active participant of scientific conferences, webinars, master classes in the field of aesthetic medicine.

Federal State Budgetary Institution National Medical Research Center
Endocrinology
Ministry of Health of Russia

Didn’t find the answer to your question?
Call and ask our specialists by phone +7 (495) 500 00 97 or write +7 (910) 455 34 97

heads) is a method of introducing vitamins, amino acids, hyaluronic acid and vascular preparations into the scalp to improve the nutrition of the hair follicles and stimulate the blood circulation of the scalp. The technique is aimed at combating hair loss, baldness (alopecia).

In the development of baldness, a significant role is played by: genetic predisposition, hormonal imbalances, infectious and allergic diseases of the scalp (seborrhea), chronic diseases (diabetes mellitus, thyroid disease), adverse environmental factors, stress, diet. And of course, treatment should be comprehensive. Mesotherapy of the scalp (hair) helps to eliminate hair loss and accelerate their growth.

Hair mesotherapy treatment:

• stops hair loss,
• accelerates growth,
• normalizes sebum secretion,
• thickens hair,
• improves their structure and appearance,
• helps eliminate dandruff.

To improve hair growth we use:

Procedure description

Intensive course: 4-6 treatments

1. Administration of the drug: intradermally, with thin and short needles, in very small doses.
2. Rehabilitation: none, slight soreness is possible when touched for 2-3 days.
3. Result: cessation of hair loss – after a month, increased growth – after 1.5 -2 months.
4. Supportive procedures: the schedule is selected individually; on average 1 procedure in 2 months.

Do not forget about the need to eliminate the cause of hair loss or treat the disease that provokes baldness. For each patient, cosmetologists additionally prescribe the necessary examinations and prescribe consultations of related specialists. In the injection treatment of hair loss, plasma therapy of the scalp also helps, which is well stimulated by the growth of “sleeping” hair.

Contraindications

• acute infectious and exacerbation of any chronic disease,
• pregnancy and lactation,
• Oncological diseases in the acute phase, the period of chemotherapy, radiation therapy,
• Individual intolerance to the components of the drug.