Open Access Revisão por pares

Letter to the Editor - Year 2026 - Volume 41Issue 1

Vigilance and Photoprotection of the Scalp: An Often-Neglected Site for Skin Cancer

Vigilância e fotoproteção do couro cabeludo: Uma área frequentemente negligenciada quanto ao câncer de pele

Hudson Dutra Rezende1,; Youssef Khayat de Paula Doumit2; João Henrique de Oliveira Aurich1; Sandra Lopes Mattos Dinato1

http://www.dx.doi.org/10.1055/a-2788-2905

Dear Editor,

We have read with great interest the article by Macedo et al., “Dermatofibrosarcoma Protuberans of the Scalp: Case Report”, which was recently published in Revista Brasileira de Cirurgia Plástica1 The authors should be congratulated for reporting a rare cutaneous neoplasm in a challenging anatomical site and for emphasizing the importance of accurate diagnosis and appropriate surgical management. Case reports addressing uncommon tumors of the scalp are particularly valuable, as they contribute to clinical awareness and help prevent misdiagnosis and delayed treatment, which are well known to increase local recurrence rates and morbidity.

From our experience coordinating a dedicated skin cancer outpatient clinic at Fundação Lusíada, in the municipality of Santos, state of São Paulo, Brazil, this case also highlights broader issues related to scalp oncology that deserve attention. Despite being a site of cumulative ultraviolet exposure, the scalp is often insufficiently examined during routine dermatological consultations. Active surveillance of the scalp in the search for neoplastic lesions is less consistent when compared to other photoexposed areas such as the face, neck, and upper limbs. This reduced vigilance may contribute to delayed diagnoses, particularly when lesions are partially concealed by residual hair or misinterpreted as benign conditions. Importantly, the identification of rare tumors such as dermatofibrosarcoma protuberans should serve as a clinical alert to the wide spectrum of malignant neoplasms that may arise in this anatomical region, including basal-cell carcinoma, cutaneous squamous-cell carcinoma, and melanoma.2–4

In addition to limited surveillance, photoprotection of the scalp remains underemphasized in the daily practice. Preventive counseling frequently prioritizes facial and cervical photoprotection, while specific guidance regarding scalp protection is often overlooked. This issue is particularly relevant in patients with androgenetic alopecia or advanced hair thinning, who are exposed to chronic ultraviolet radiation over many years. Evidence2,3 suggests that hair plays a protective role against ultraviolet-radiation damage, as a physical barrier and through local immunological mechanisms, and its absence is associated with an increased risk of scalp carcinogenesis.

Moreover, several studies3–5 have demonstrated that scalp neoplasms, particularly melanomas and squamouscell carcinomas, tend to present with greater tumor thickness, more aggressive biological behavior, and worse prognostic outcomes compared with thoe of similar tumors located elsewhere on the body. Therefore, the case report in question reinforces the importance of incorporating routine scalp examination, targeted photoprotection counseling, and to promote increased awareness of skin cancer risk in patients with alopecia into the standard dermatological and surgical practices, while also making a meaningful contribution to the literature on an often-neglected anatomical site.

REFERENCES

1. Macedo JLS, Espíndola JMRBA, Vasconcelos TO, et al. Dermatofibrosarcoma protuberans of the scalp: case report. Rev Bras Cir Plást 2025;40:s00451807279. Doi: 10.1055/s-0045-1807279

2. Rezende HD, Delgado JC, Fukuma LO, Campos MS, Dinato SLME. Male baldness and skin cancer: what are we missing in daily practice? Rev Assoc Med Bras 2024;70(11):e20241303. Doi: 10.1590/1806-9282.20241303

3. Li WQ, Cho E, Han J, Weinstock MA, Qureshi AA. Male pattern baldness and risk of incident skin cancer in a cohort of men. Int J Cancer 2016;139(12):2671–2678. Doi: 10.1002/ijc.30395

4. Porto AC, Blumetti TP, Santos Filho IDAO, Calsavara VF, Duprat Neto JP, Braga JCT. Primary cutaneous melanoma of the scalp: Patterns of clinical, histological and epidemiological characteristics in Brazil. PLoS One 2020;15(10):e0240864. Doi: 10.1371/ journal.pone.0240864

5. Castanheira A, Soares P, Boaventura P. Scalp basal cell carcinoma: A different entity? Dermatol Ther 2019;32(02):e12828. Doi: 10.1111/dth.12828











1. 1Department of Dermatology, Centro Universitário Lusíada (UNILUS), Santos, SP, Brazil
2. 2Department of Internal Medicine, Universidade Nove de Julho (UNINOVE), Bauru, SP, Brazil

Data Availability Data will be available upon request to the corresponding author.

Financial Support The authors declare that they did not receive financial support fromagencies in the public, private, or non-profit sectors to conduct the present study.

Address for correspondence Hudson Dutra Rezende, MD, MSc, Departamento de Dermatologia, Centro Universitário Lusíada (UNILUS),Rua OswaldoCruz179, Boqueirão,Santos, SP,CEP: 11045–101, Brazil (e-mail: contato@hudsondutra.com.br ).

Article received: December 28, 2025.
Article accepted: January 13, 2026.

Conflict of Interests The authors have no conflict of interests to declare.

Editor-in-Chief: Dov Charles Goldenberg