What is nodular melanoma?

This page was reviewed under our medical and editorial policy by

Frederick L. Durden, Jr, MD, Plastic and Reconstructive Surgeon & Microsurgical Reconstructive Surgeon

This page was reviewed on February 24, 2023.

Nodular melanoma makes up about 10 to 15 percent of all melanoma cases. Considered one of the most aggressive forms of skin cancer, nodular melanomas tend to grow quickly and spread downward into the skin’s deeper layers. They may be found anywhere on the body. Unlike other melanomas, nodular melanomas don’t typically start with existing moles.

What are the causes and risk factors of nodular melanoma?

Nodular melanoma isn’t as strongly linked to sun exposure as other melanomas. It occurs when melanocytes (pigment cells) become malignant (cancerous). Melanocytes are found among basal cells in the skin’s outermost layer, called the epidermis. The malignant cells tend to appear in normal-looking skin and aren’t typically linked to existing moles.

While it’s not fully understood why melanocytes become malignant, it likely stems from changes in DNA (genetic material).

Nodular melanoma risks include:

  • Gender (more common in males)
  • Advancing age (over age 50)
  • Personal history of melanoma
  • Multiple moles, including atypical ones
  • Fair skin (although nodular melanoma may occur on darker-skinned individuals, too)

What do nodular melanomas look like?

Nodular melanomas are often found on the torso, neck or scalp. Appearance-wise, they may:

  • Be elevated, dome-shaped lumps or bumps (and sometimes look like mushrooms with stems)
  • Resemble blood blisters or other non-cancerous lesions
  • Have regular, symmetrical borders
  • Look dark brown, black or red (though they may also have no color)
  • Have smooth, rough or crusted surfaces
  • Be larger than most moles

They may also:

  • Bleed or ooze
  • Itch or sting
  • Grow quickly
  • Feel firm

How is nodular melanoma treated?

Surgery to remove the cancerous cells is the main treatment for nodular melanoma. Surgeons may remove healthy skin around the lump to try to remove all remaining cancerous cells. They may also remove nearby lymph nodes if they suspect the cancer has spread. Sometimes, the surgeon will create a flap or skin graft to close the wound.

The patient may need a second surgery or radiation therapy to kill remaining cancerous cells left behind after the first surgery.

To treat advanced or spreading nodular melanoma, doctors may also consider immunotherapy or targeted therapy.

What is the survival rate for nodular melanoma?

Melanoma survival rates vary based on the type of melanoma, the thickness of the primary melanoma and how far it’s spread. For all types of melanoma combined, the five-year survival rate is 93 percent, according to the American Society of Clinical Oncology.

However, nodular melanoma is more aggressive and challenging to treat. Some studies have noted a five-year survival rate for nodular melanoma is much lower than other types of melanoma.

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