I was at the salon for my monthly cut and color. As Manolita rinsed my hair, she made a casual comment: “There’s dirt on your scalp,” she said. “Try washing it off,” I replied. “Dr. Debby, it’s not coming off,” Manolita said. I asked her to take a photo of it with my phone and as I examined it, I started to worry. The bluish-black mark that she thought was dirt had every warning sign of a scalp melanoma. As a dermatologist, I am very familiar with the ABCDE, a way of identifying melanomas. My mark was asymmetrical, with irregular borders, its color ranged from dark brown to jet black, it covered a large diameter, and it evolved (or in this case appeared). The hair stylist, Tasso, who I have seen every month over the past 20 years, rushed over and attempted to console me. But he said the worst thing he could (of course, he didn’t know it). “Debby, Debby, calm down … It is a new spot,” he said. I began shaking and crying as I thought, “This is utterly ironic.” In my practice, I routinely provide full body examinations for my patients, including a scalp checks, to screen for melanoma. But I had neglected to look at my own head. I knew that a new mole that suddenly appeared could be scalp melanoma. While it is more common for women to find melanomas on their legs, scalp melanoma has a higher mortality rate. People with scalp melanoma are twice as likely to die as those with melanomas in other locations. We’re still not exactly sure why they’re so deadly, but we have some educated guesses: Scalp melanomas often go undetected until they’re already in a late stage. And, it’s possible that the scalp, with all its complicated blood vessels, provides a unique breeding ground for cancer. We have also considered that because the scalp is so close to the brain, melanomas originating there quickly spread to the brain. I had them finish rinsing my hair out and skipped my haircut. I called my husband, Dr. Robert Gotkin, a plastic surgeon and partner at our practice, Cosmetique Dermatology, Laser & Plastic Surgery. I asked him to meet me at the office to biopsy the mole. But this was Friday. We wouldn’t get the lab report back until Monday, at the earliest. The next 72 hours were hell as all the "what ifs?" ran through my mind. When the phone rang on Monday morning, I couldn’t answer it. I forced my husband to do it. The results were in — it was benign. It was a harmless blue nevus, a mark that mimics the appearance of melanoma, but does not behave like melanoma. It is not cancerous and does not spread. Courtesy Dr. Deborah Sarnoff Fortunately, the dark mark on Dr. Deborah Sarnoff's scalp turned out to be benign. I rushed to the salon to thank Manolita and Tasso for saying something. I stressed how what they said could have been life-saving and encouraged them to do the same for others. While I felt relieved, I wanted my experience to help others. I started the Heads Up program through the Skin Cancer Foundation, a New York-based nonprofit where I serve as senior vice president. Heads Up trains hairdressers, massage therapists, and aestheticians to know what to look for when working with clients’ scalps. We’re not asking them to make diagnoses, but we want them to speak up if they see something amiss. It is very tough for people to see their own scalp — a hairstylist is better able to notice a new mole or a changing one. But it’s also important that these professionals tell their clients about a mole in a way that does not scare them or sound off-putting. My experience serves as a reminder that early detection through examination is key in curing melanoma. Even my fellow dermatologists have said, “Wow, I better look at my head.” source
