Epidermal field carcinogenesis in bald-headed: An attempt at finetuning early non-invasive detection.

Skin weathering and photoaging of the balding scalp have not attracted much investigative attention so far. However, the concept of field cancerization, in particular actinic field carcinogenesis, is likely applicable to this part of the body. The aim of the study was to finetune the epidermal actinic changes present on hairlessness scalp. The ultraviolet light-enhanced visualization (ULEV) method was used to assess a series of 50 healthy men older than 50 years with documented baldness for over 15 years. They were scrutenized looking for altered epidermal structures corresponding to photoaging-associated changes. Attention was focused on the faint mosaic melanoderma (FMM) and atypical scaliness. Observations were made on the scalp and forehead. FMM was recognized in each case. It presented either as a single manifestation of photoaging or it was associated with an unusual pattern of discrete rimmed scaliness. In this latter case histology and morphometry disclosed keratinocyte dysplasia. A similar scaly pattern was not seen on the forehead. Subtle skin surface changes were disclosed on long-standing sunexposed balding scalps. The scaly aspect was distinct from dandruff, seborrheic dermatitis or any other common inflammatory scalp dermatosis. The presently described changes had not previously been described during early balding. It is suggested that the presently described condition may be associated with or indicative for actinic field carcinogenesis and incipient keratinocyte dysplasia.