Nodular Melanoma

Nodular melanoma is an aggressive form of skin cancer that causes raised nodules or lesions on the skin. It tends to grow downward into the skin (often referred to as vertical growth) more quickly than some other types of skin melanoma. Because much of its growth is under the skin, it can be harder to spot changes to the skin that may be signs of nodular melanoma.

Nodular melanoma occurs when cells in the body called melanocytes begin to mutate on a genetic level. These mutations cause the cells to grow abnormally and form a nodule or lesion on the skin. Sometimes, a person may have another form of skin melanoma that then becomes nodular melanoma.

Some of the risk factors that make it more likely a person will develop nodular melanoma include:

• Being an older adult
• Being male
• Having a greater number of moles on the skin than average
• Having had too much exposure over time to ultraviolet light, either from natural sources like the sun or from artificial sources like tanning beds

Diagnosing nodular melanoma most frequently involves taking a sample of the melanoma nodule (a skin biopsy) and analyzing it in a lab. Some of the tests used for diagnosing nodular melanoma include:

• An excisional biopsy, which removes the entire nodule and some of the surrounding tissue
• A “scoop and shave” biopsy, which uses a tool that removes the nodule and a semicircle of tissue beneath and around it
• Lab tests to analyze the sample for signs of cancer on a cellular level
• A sentinel lymph node biopsy, which can check for signs of cancer in the lymph nodes close to the initial nodule

Staging cancer is the process of using tests and lab analyses to determine how advanced the cancer is. Nodular melanoma is staged in a similar way to most other types of melanoma, mostly based on how big or thick the melanoma nodule is and whether the cancer has spread beyond its original site.

Read about the melanoma stages

Most cases of nodular melanoma are treated using surgery. An experienced surgeon removes the lesion or nodule from the skin, along with a small amount of healthy tissue around the nodule. The amount of healthy tissue that is removed depends on how wide and deep the nodule is. In some cases, patients may need a second surgery or radiation therapy to ensure that no cancer cells remain.

Patients with nodular melanoma are cared for by a multidisciplinary cancer care team that may include:

• Dermatologists, who are experts in diagnosing and treating conditions of the skin
• Mohs surgeons, who are specially-trained surgeons who act as the pathologist and surgeon and can provide real-time analysis of the margins
• Surgical oncologists with expertise in a wide range of procedures for diagnosing and treating nodular melanoma
• Medical oncologists, who specialize in using cancer-treating medications including chemotherapy and immunotherapy
• Radiation oncologists, who are experienced in all types of radiation therapy to treat cancer
• Trained oncology nurses who may work with patients as they undergo treatment
• Supportive care specialists, who provide a variety of services designed to support patients’ emotional, physical and mental health during and after treatment

The overall five-year survival rate for patients diagnosed with early-stage nodular melanoma is very good, at around 99%. However, those who are diagnosed with more advanced nodular melanoma that has spread to nearby lymph nodes have a 66% five-year survival rate. Late stage nodular melanoma has an equivalent survival rate of around 27%.

Patients should talk to the care team to get an individualized prognosis based on their specific cancer subtype, stage and other health factors.