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  • Nodular Melanoma

    Nodular melanoma is the most aggressive form of melanoma (a skin cancer), accounting for 15% of all diagnosed cases. This disease is difficult to detect because it is often colorless or light in pigmentation. Nodular melanoma can also appear as a dark black or blue pigment lesion, resembling a blood vessel.

    This form of skin cancer is unique because of it grows deep within the skin, as opposed to spreading across the skin’s surface like most skin cancers. Nodular Melanoma is very life threatening and demands treatment immediately following diagnosis.

    Risk Factors

    Risk factors associated with nodular melanoma development include:

    • Number of Moles: Often having 100 or more moles increases your risk of developing nodular melanoma.
    • Family History: Most patients that develop nodular melanoma have a parent or sibling with the disease.
    • Weakened Immune System: Nodular melanoma often develops in people with a weakened immune system. Organ transplants and certain medication may result in a weakened immune system.
    • Sun Exposure: Over exposure to the sun’s ultraviolet rays throughout life is the leading cause of nodular melanoma.
    • Xeroderma Pigmentosum: This rare, heredity skin disease, caused by a defect in the enzyme that normally repairs ultra-violet damaged DNA, may lead to the development of nodular melanoma.
    • Age: Occurs primarily in adults 60 and older.
    • Sex: Men are more likely than women to develop nodular melanoma.

    Signs and Symptoms

    The most common technique used to identify the signs and symptoms of Nodular Melanoma is the acronym ABCDE:

    • Asymmetrical skin lesion
    • Border of area is irregular
    • Color varies from brown, to tan or pink (cracking, bleeding, and itching can also occur)
    • Diameter of mole is greater than 6mm causing pain and sensitivity
    • Evolution of mole is a sign of malignancy

    Outlook (Prognosis)

    A poor prognosis is associated with nodular melanoma because of its aggressive metastasis (spread).


    If nodular melanoma runs in your family, you should have annual skin exams. Self-examination is also effective. Taking progressive photographs of the suspect area will help a skin care physician or doctor evaluate the disease’s behavior.

    Everyone should wear quality sun screen with an SPF rating of 30 or more.

    Diagnosis and Staging

    Nodular melanoma is diagnosed using an excisional or punch biopsy. Excisional biopsies remove the entire lesion. This procedure is infrequently recommended because it tend to result in lesion recurrence. A punch biopsy is preffered diagnostic method for nodular melanoma. This procedure involves taking several small samples of the lesion to be further examined in a laboratory.

    Other diagnosis options include: X-rays, CT scans, MRIs, PET and PET/CTs, ultrasounds, and LDH testing.


    Once a patient is diagnosed, the next step is to remove the abnormal mole. This usually leaves a scar. Surgery, where a wide, local incision is made is the most common nodular melanoma treatment option, but it can result in a high risk of the lesion returning.

    Radiation (the use of ionizing radiation beams to kill cells) and chemotherapy (the use of chemical agents to kill cells) are sometimes used to treat nodular melanoma. These treatments yield mixed results.

    After the lesion is removed, it should be submitted to a laboratory for microscopic evaluation. Following treatment, it is recommended to make frequent visits to your doctor, dermatologist, or skin care specialist for followup examinations.