What Is Nodular Melanoma and What Does It Look Like?

Generally, Melanoma progresses through four stages that end with metastasis, which is when the cancer spreads beyond the initial tumor.

These stages can be further summarized into two stages: First, when it grows outward (radially), and second, when it grows into the skin (vertically). The second stage is usually when the nodule forms.

However, modular melanoma skips the radial phase and moves straight into the vertical phase. This means it begins as a new growth, rather than developing within a preexisting mole, which allows it to progress faster to metastasis.

Most skin cancer screening guidelines tell you to check for the ABCDE symptoms of skin cancer. However, there are additional warning signs that can alert you to possible nodular melanoma.

First, melanoma growths are often blue or black, though they may not have a distinct color in some cases.

Other warning signs to watch out for include:

• Color: A growth that differs in color from other spots or moles on your body.
• Diameter: Bumps or growths that are more than 6 millimeters in diameter or that continue to grow.
• Evolving: Lesions, moles, or skin growths that change shape, color, or size over time.
• Elevation: Increased elevation of a skin bump or spot could be a red flag that something may be wrong.
• Firmness: Nodular melanomas are often very firm to the touch.
• Growth: New developments that continue to grow after 2 or 3 weeks should be brought to the attention of a doctor.

Nodular melanoma happens when melanocyte cells in your skin mutate and become cancerous. Melanocytes are the cells in your skin that make melanin. This is the pigment that gives your skin its color.

Sometimes, these cells can mutate after exposure to ultraviolet (UV) radiation from the sun, or from things like lasers and tanning beds.

If you get too much exposure to UV radiation, it can damage the DNA of your skin cells. This can lead to mutations in the DNA, causing the cells to grow out of control.

Exposure to UV light can cause mutations in skin cells and lead to multiple types of skin cancer. Scientists don’t know exactly why this sometimes causes nodular melanoma and not other melanomas.

However, there are some risk factors that may increase the chance of developing nodular melanoma.

Other than UV light exposure, these include having very light skin, a family history of nodular melanoma, a history of other cancers, certain inherited genetic mutations, or having five or more moles that have unusual features.

In addition, about 5% of melanomas develop in males assigned at birth (MAAB) and 4% in females assigned at birth (FAAB). The average age of diagnosis is 57 years. Nodular melanoma specifically is diagnosed in 15-30% of melanoma cases.

See a doctor immediately if you have a skin bump, growth, mole, or lesion that:

• is larger than most regular moles or spots on your body
• used to be flat but is now elevated or thicker than it used to be
• is dome-shaped or has a firm lump
• is either a single color (black, brown, red, pink, or flesh-colored) or a mix of colors (e.g., blue-black, brown-red)
• has either a smooth or rough, crusted surface
• has changed in its appearance
• itches or stings

If you’re not sure whether a bump or growth meets these criteria, it’s better to be safe and have it checked out. There is no downside to being cautious and careful when it comes to your health.

To determine whether you have melanoma, a doctor will begin by first asking for details about:

• your exposure to the sun
• any personal or family history of skin cancer
• when you first noticed the growth on your skin
• how or if it has changed in shape, color, size, or elevation

During your visit, your doctor will also carefully examine your skin with a high-quality magnifying glass that allows them to get a much more detailed view of the growth on your skin. They will likely also check for enlarged lymph nodes.

The next step may involve a biopsy of the mole or growth. This is the most accurate way to diagnose nodular melanoma.

A doctor may also recommend a lymph node biopsy so they can see if any cancer cells have spread to your lymph nodes.

Treatment of nodular melanoma typically involves surgically removing the melanoma and some of the healthy skin surrounding the growth.

Melanoma that has spread to lymph nodes or internal organs requires additional treatment to destroy the cancer cells. This may include:

• immunotherapy such as checkpoint inhibitors.
• targeted therapy such as MEK or BRAF inhibitors
• radiation
• chemotherapy

Each type of treatment has its own side effects. It’s important to discuss the side effects of these treatments with your doctor so you can make the most informed choice about your treatment.

Nodular melanoma can happen to anyone, but taking certain precautions may help lower your chance of getting this type of cancer:

• Use sunscreen with a sun-protective factor (SPF) of 30 or higher, and reapply often, including on your lips.
• Avoid direct sun exposure between 10 a.m. and 4 p.m. every day, and always choose shade.
• Wear sun-protective clothing such as wide-brimmed hats, sunglasses, or long clothing.
• Avoid tanning beds and indoor tanning booths.

Nodular melanoma is more aggressive than other types of melanoma and becomes more difficult to treat once it has spread beyond the initial area where it developed.

According to research, the 5-year survival rate for nodular melanoma is 51.67%. However, statistics show that if any type of melanoma is found, diagnosed, and treated before it begins to spread, the 5-year survival rate is much higher, between 95-100%.

This is why it’s always better to err on the side of caution when it comes to possible signs of cancer.

Where is nodular melanoma commonly found?

The most common growth sites for nodular melanoma are the neck, head, and trunk of the body. That said, it can take as little as 3 months for this type of cancer to spread internally and progress to an advanced stage.

What does nodular melanoma feel like to touch?

Nodular melanoma is hard to the touch and more even in its shape than other types of melanoma.

What are the symptoms of nodular melanoma spreading?

If melanoma spreads, you may begin to experience symptoms beyond the site of the growth. This may include swollen lymph nodes, shortness of breath, headaches, unexplained weight loss, or bone pain.

Is nodular melanoma painful?

Melanoma lesions are not usually painful, but they can be in some cases, according to research.

Nodular melanoma is an aggressive form of skin cancer.

Although this type of skin cancer can happen to anyone, it’s more common in lighter-skinned people who’ve had multiple sunburns or a lot of exposure to the sun or tanning beds.

If you notice any skin growth that looks unusual or has concerning characteristics, get it checked by a medical professional at your earliest opportunity. The sooner nodular melanoma is diagnosed and treated, the higher the chance of a successful outcome.