A hairy finding on this scalp

The elderly bald male scalp can be a minefield.

Often there is a mixture of solar keratoses, SCC in situ and invasive SCC but in this case it was a melanoma in situ in among multiple seborrhoeic keratoses.The melanoma is the darker area indicated by the arrow. Several of the other darker and scaly areas here were examined by shave biopsy but they were all seborrhoeic keratoses. A dermatoscope is very useful in examining these patients and eliminating some areas from biopsy. Surface scale is less likely with a melanoma in situ however even with the dermatoscope it can be difficult to distinguish between a dark flat seborrhoeic keratosis and a melanoma in situ. For dermatoscopic and histology views log into www.skinconsult.com.au