Tumors and Growths that Occur on the Scalp

Our scalp is something we don’t really get the opportunity to get so familiar with.  Unless you have ever shaved your hair clean off, it is unlikely that you know exactly how your scalp looks. The natural contours as well as natural lumps and bumps such as moles on your scalp are something therefore that you may have not had a close encounter with. Sometimes however we do come across a lump on our scalp that causes us concern. I will explain below a few of the most common concerns that patients come to see me about.

Most lumps and bumps that are discovered on the scalp are harmless. Usually discovered by a patient or hair stylist as a result of massaging oil or shampoo onto their scalp, I then get an urgent call and a subsequent appointment made for consultation. This is of course the most sensible thing to do when you find any lump on your body that causes you concern- even if it is simply to put your mind at ease; it is always worth investigating and never something to feel foolish about.

So what are the lumps and bumps that I commonly see as a dermatologist?

Pilar cysts

These cysts come in an assortment of sizes- ranging from pea-size to that of a small apple. Emerging as a round, firm lump on the scalp, these painless lumps are a frequent cause of concern for many patients that I see. Relatively harmless, these cysts are formed by the collection of oil and dead skin cells that collects under the top layer of the scalp. These should be removed as they can put pressure on hair follicles, resulting in the hair falling out and they can also become infected. The hair growth cycle is then stunted, with the hair growth ceasing. Bear in mind, this failure to grow back is only temporary. Once the pilar cyst is removed, the hair grows back. This type of cyst can be removed as an office procedure using a local anesthetic. For some reason, these cysts are more common in females and hereditary.  On several occasions I have had mothers and daughters both come in to get the growths removed.

Common Warts

These are certainly nothing to panic about! Warts are a common skin problem and appear on various parts of the body including the scalp. They are usually brought on by the human papilloma virus, most commonly referred to as HPV. This virus enters the skin surface usually via a cut or injury and then grows from the skin as a hard cluster or clump. While not a dangerous growth, many people find warts annoying and embarrassing. When this growth is on the scalp, it can get in the way of combing or brushing of the hair. Most of the time, you can feel that something is there, but it  is hard to really know that it’s a wart unless you use a mirror or get someone else to look at the areas.

The good news is, removal is certainly a possibility and is easily carried out in the doctor’s office. These is usually done via freezing the growths with liquid nitrogen or removing them with electro surgery using a needle that sends an electrical charge through the wart thus vaporizing the growth so that the hardened tissue can be scraped off. Wart removal does result in mild pain that is short-lived and well worth the results.

Seborrheic keratoses

These can be a wart-like growth in appearance the difference being there is no association with the HPV virus. The color of these lumps can vary from colorless to dark black, but they are usually brownish or beige. They are hereditary and very, very common occurring frequently on the face, trunk, and other body areas. These are frequently round or oval in shape with flattish surfaces, but if they get irritated, they can be more irregular in shape or change color. However, it is highly unusual and unlikely for these growths to become cancerous.  Most individuals get them removed because they become itchy or irritated or get in the way when the hair is combed or brushed.

Moles or Nevi

Moles of 3 different types can develop on the scalp just as they do on pretty much every other part of the body.

Intradermal Nevi (IDN) is a type of mole that is flesh colored and raised above the skin surface. While they are usually benign, other growths can have a similar appearance. They are usually removed for cosmetic reasons more than anything else.

Nevus Sebaceous of Jadassohn

This is a growth of tissue on the scalp that usually starts out as a small yellow patch that is initially detected during infancy or early childhood.  The lesions become raised and thickened during puberty and adolescence with a surface that is rough with the texture of cobblestones.  The significance of these lesions is that there is a 10% chance that a basal cell skin cancer can develop so they are usually removed on a preventative basis.

Cancerous Growths of the Scalp

A number of growths that are associated with sun exposure can develop on the scalp, especially in bald men.  These growths can appear in different sizes and shapes ranging from a pinhead to the size of a golf ball.  Early detection and biopsy of any suspicious lesions is the way to make a diagnosis and treat appropriately. Here are some of the growths that a biopsy can show.

• Basal Cell Carcinoma – localized skin cancer that is waxy in appearance
• Squamous Cell Carcinoma – usually appears as a thickened crusty plaque that won’t heal
• Merkel Cell Tumors – appear as raised red nodules that grow rapidly; rare and aggressive and associated with a polyomavirus
• Melanoma – malignant growth that develops from moles and has color variation with irregular borders.

So, as you can see there are a varied number of lesions that can appear on the scalp.  These tumors and growths are best diagnosed by a dermatologist or other physician trained how to recognize the growths.  Since it is hard to evaluate a growth on your scalp without assistance, see your physician right away if you have any concern.