Melanomas of the scalp are usually thicker and show a worse prognosis than other sites and other head and neck melanomas. One hypothesis to explain this aggressive behavior could be diagnosis delay attributed to hair concealment of lesions. The researchers and doctors included the scalp’s primary melanomas over two decades at four reference centers in Australia and Italy. Hair coverage and visibility of the lesions were assessed on preoperative photographic documentation by two investigators and correlated with prognostic factors. Patients records and pathology reports provided clinical and histological data.

The study showed that most 113 melanomas included were located on easily visible areas of the scalp – hairless scalp or hairline. The remaining ones, considered hair‐covered, showed more frequent thinning of hair than a dense hair coverage. Melanomas of “hairy scalps” were more frequently invasive and had higher median Breslowthan than those on bald scalps or areas with thinning hair. However, when considering only the invasive cases, Breslow thickness and mitotic rate were not statistically different between concealed and easily visible locations. Melanomas detected by a doctor were thinner than those first noticed by the patient, relatives, or a hairdresser. Most scalp melanomas arose on easily visible areas, which are more prone to ultraviolet damage. Hair‐covered ones, despite rare, could be overlooked during the examination. Proactive screening of the scalp area should be encouraged.