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Published on June 25, 2019

Your hairdresser could save your life

hairdresser saving lives

A few years ago, I noticed my hairdresser, Caroline Smith, studying my scalp. When I asked her about it, she explained that she always checks her clients’ heads for skin cancer.

“It’s an extra service I provide,” she said.

Smith, who owns a salon in Harwich Port, has a long-established business and almost all of her clients are regulars. That puts her in a perfect position to notice any changes that come along. She didn’t learn to do the scalp checks while in hairdressing school; it was her clients that gave her the idea.

“I know a lot about skin cancer because a lot of my clients have had it,” she said. “They have shown me what it looks like, not on their head but on their body. Also, I have extremely fair skin, so I go to the dermatologist regularly and she always checks in my hair at every appointment.”

While she is cutting hair, Smith parts each section, which gives her a close-up view of the person’s scalp. She has found suspicious spots and recommended that people see their doctor, but thankfully, none have turned out to be melanoma.

“Some clients will have scabs and it ends up being eczema and because it’s on their head it’s a little more sensitive and they scratch it and it becomes inflamed,” she said. “I’ve also found ticks.”

There is a national movement to train more hairdressers led by dermatologist Deborah S. Sarnoff, MD, FAAD who is also president of the Skin Cancer Foundation. Dr. Sarnoff had a scare when her own hairdresser found a suspicious mole on her head. The mole turned out to be benign, but the incident frightened her enough to create an educational program called Heads Up! to train hairdressers to look for scalp and neck cancers.

The Melanoma Research Foundation also has a training program called Mark the SPOT! that trains stylists to do cancer screenings with their clients.

A hairdresser is uniquely qualified to detect cancers on the scalp, which tend to be more aggressive and, in the case of melanoma, deadly, said Peter Hopewood, MD, from Cape Cod Surgeons in Falmouth. Dr. Hopewood’s specialty is cancer care and he works with the American Cancer Society doing outreach.

“The thing about hairdressers is they wash your hair so they have their hands on your head,” he said. “They will know if they feel something that is off. Don’t ignore it if someone finds something.”

What to Watch For

There are three types of skin cancer, described by Dr. Hopewood:

  • Basal cell cancer: These cells usually don’t travel. They slowly enlarge and look like a very dry hole.
  • Squamous cell cancer: This is usually fleshier and can have bleeding edges. It looks like a crater on the moon with mountain ridges on the edges.
  • Melanoma: They can be flat or raised. They are usually a little thick and have classic ABCDE warning signs.

The ABCDE warning signs of melanoma:

  • Asymmetry
  • Borders are irregular
  • Colors like mottled black or purple rather than the usual brown
  • Diameter bigger than an eraser head
  • Evolution of the mole with changes to a mole or a new mole that previously didn’t exist

Melanoma begins aggressively, Dr. Hopewood said, and it spreads quicker on the scalp than other areas of the body. The first reason for this is that it goes down four different lymphatic drainage paths rather than just one.

“It’s aggressive because the skin is thinner on the scalp and it’s got a better circulation,” he said. “The scalp has very high circulation. But also, the repeat sun exposure probably hurts it and maybe it’s just found a little bit later because people don’t look in their hair all the time.”

One of the difficulties with melanoma on the scalp is that it is harder to close the wound when the cancer is removed, according to Dr. Hopewood. Unlike the fleshy parts of the body like the stomach or thighs, the skin on the head doesn’t have very much mobility or give to it. A thin early melanoma needs a one-centimeter margin around it, so the wound would be about the size of a quarter. A thicker melanoma would need a full inch margin on all sides, creating a two-inch wound.

Because of the size of the incision, in both cases a skin graft would be necessary to close the wound, he said.

Don’t See a Hairdresser Often?

Early detection is the key with melanoma, so if you don’t regularly visit a salon, ask a loved one to examine your scalp on a regular basis. If he or she finds something unusual, take a photo of it to bring to your doctor. There are also telephone apps like SkinVision that allow you to do self-checks for skin cancer.

Recently on the Cape, some healthcare providers, like the Community Health Centers of Cape Cod, are exploring the use of teledermatology groups because it’s hard to get into a dermatology office quickly. Primary care physicians can take a photo of a suspicious mole with a ruler next to it and submit it to a teledermatology group along with a short patient history. The teledermatology group then informs the physician whether the mole warrants a biopsy.

“If a patient does a cold call to a dermatologist, saying ‘I’ve got a funny looking mole,’ it may take a few months to get an appointment,” Dr. Hopewood said. “But if the doctor’s office is saying I’ve got a patient with a funny mole and we had a teledermatology say it needs to be biopsied because they are suspicious it might be melanoma, they’re going to get you in within a week. It’s kind of like when you call CVS for a prescription, doctors press 2. It’s a faster track because it’s already been triaged.”