Nodular Melanoma

Nodular Melanoma (NM)

Nodular melanoma is the second most common type occurring in approximately 15-20% of melanomas. Because of its pure vertical growth phase, it is the most aggressive and requires vigilant treatment.

NM usually occurs on sun-exposed areas like the head (scalp in men), neck, trunk, arms and legs but can arise anywhere. It is more frequent in males than females, most common during middle age, and generally doesn't grow from an existing mole starting instead as a new growth of its own.

Growth is rapid both below and above the skin frequently achieving a visible diameter of 1-2 cm or larger. Because of this, they are easy to notice, often resembling a blood blister. Unfortunately, most people wait an average of nine months to have a lesion checked. NM grows in weeks to months, not months to years.

It is distinguished by it's dark coloring, often black or blue-black, it may also have gray, red or brown coloring or lack color all together and appear fleshlike. NM is regularly dome-shaped, round and smooth, sometimes causing it to be confused with blood vessel abnormalities. It can resemble cauliflower, grow from the skin on a stalk, or ulcerate. Cauliflower-shaped or polypoid nodular melanomas are ugly skin lesions that are large in volume. Both ulcerated and polypoid lesions must be examined by a physician without delay.

Nodular melanoma does not often follow the normal ABC's for melanoma. Instead, it has been suggested by Dr. John Kelly that it follows EFG's (see below), is small in size, symmetrical in shape, and even in color.

What are we looking for in early NM?

  • Small diameter
  • Symmetrical
  • Raised
  • Often Pink or Red
  • Even in color
  • Firm to palpation
  • Short history of change – one to several months

Nodular Melanoma: The EFG’s

  • E – Elevated
  • F – Firm to touch
  • G – Growing progressively over more than a month

John Kelly, MD, Head of the Dermatology Unit, Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia. See Dr. Kelly's article, "Nodular Melanoma: How Current Approaches to Early Detection Are Failing," in Vol. 22, No. 2, 2004 of The Skin Cancer Foundation's quarterly clinical publication, The Melanoma Letter.