Dermoscopy of Thick Scalp Melanoma: Is It Always an Easy Diagnosis?

This study investigates the dermoscopic features of thick scalp melanoma (SM), which is often more invasive and has a worse prognosis than melanomas at other body sites. The retrospective case-control study involved 30 cases of scalp melanoma with a Breslow thickness of ≥0.8 mm, compared to 63 dorsal melanomas. The findings reveal that thick SM frequently exhibits characteristics typical of head and neck melanomas, with 40% resembling lentigo maligna melanoma and 40% positive for the blue-black rule. However, 20% of cases could be mistaken for non-melanocytic lesions such as basal cell carcinomas, squamous cell carcinomas, angiomas, or seborrheic keratoses, complicating clinical-dermoscopic diagnosis. The study highlights the importance of accurate preoperative diagnosis due to the varied dermoscopic appearance of SM.