[Tumors of the scalp: special aspects of selected examples]

Tumors of the scalp display some clinical, histological and prognostic characteristics. Early recognition of tumors is hampered by dense hair growth which can result in delayed diagnosis.

Taking current literature into consideration atypical fibroxanthoma, cutaneous angiosarcoma, melanoma of the scalp, some adnexal tumors including the proliferating trichilemmal tumor as well as cutaneous metastases from visceral malignancies will be discussed.

Based on the fact that early scalp tumors are clinically difficult to recognize, they are often diagnosed at a late stage. Angiosarcomas belong to the most aggressive skin tumors and show a rapid growth with unfavorable prognosis. Malignant melanoma on the head has a more serious prognosis in comparison to other locations of the body. Cutaneous metastases are mostly a sign of an advanced tumor stage with a fatal prognosis. The various types of adnexal tumors are mostly benign. In exceptional cases rapid growth and ulceration may be an indicator for the development of an adnexal carcinoma. On the scalp tumors with sweat gland differentiation are more frequent than tumors with follicular differentiation. This shows that the general view that adnexal tumors develop from local adnexal structures is wrong.

Scalp lesions in which the diagnosis is unclear should be biopsied or excised early. Based on the result of the histological examination further therapy can be determined.