Malignant cutaneous tumours of the scalp: always remember to examine the head

Around 2% of cutaneous neoplasms arise in the scalp (scalp tumours: STs). They can be classified as primary STs (epithelial, melanocytic and adnexal) or metastatic (from distal tumours or as a spreading from contiguous structures). This anatomic location is usually poorly examined during dermatological consultations, also due to the presence of the hair cover. Moreover, self-examination of the hair-covered skin is often harder for the patient. The peculiar features of the scalp may explain the worse prognosis of STs compared with neoplasms of other locations. The hair coverage protects the scalp from UV radiations, but due to the complex pathogenesis of STs, they may also develop in younger patients. Until now, STs have been not extensively investigated in the dermatological literature, and most publications are written by otolaryngologists, or by head, neck and plastic surgeons. Thus, dermatologists above all have the opportunity and the task to explore the scalp carefully, with the opportunity to make an early diagnosis, possibly changing the patient's prognosis. The aim of this paper was to review the main STs in order to increase awareness among dermatology specialists.