Nodular Melanoma

What is nodular melanoma?

Nodular melanoma is a type of melanoma. It’s a type of skin cancer that develops very quickly, usually growing rapidly over several weeks or months. It grows above and below your skin (vertically), but most of the cancer is below the surface, like an iceberg.

Healthcare providers group nodular melanoma in the following stages:

• Stage 0 (melanoma in situ): The nodular melanoma is only in the top layer of your skin (epidermis). It hasn’t spread from its original position.
• Stage I: The nodular melanoma is low-risk, and there isn’t any evidence that it has spread. It’s small — less than 2 millimeters thick.
• Stage II: The nodular melanoma is thicker than 2 millimeters. It has features that indicate a higher risk of coming back (recurrence). However, there isn’t any evidence that it has spread.
• Stage III: The nodular melanoma has spread to nearby lymph nodes or nearby skin.
• Stage IV: The nodular melanoma has spread to more distant lymph nodes or skin, or it has spread to your internal organs.

Who does nodular melanoma affect?

Anyone can develop nodular melanoma. However, you’re more likely to have it if you’re a man or assigned male at birth (AMAB) and over 50 years old.

You’re also more likely to develop nodular melanoma if:

• You have had skin cancer before.
• You have a family history of skin cancer.
• You’re fair-skinned and get sunburned easily.
• You spend a lot of time in the sun.

How common is nodular melanoma?

Nodular melanoma is the second-most common type of melanoma. Approximately 15% to 20% of all melanoma diagnoses are nodular melanoma. It causes about 50% of all melanoma-related deaths.

How does nodular melanoma affect my body?

Nodular melanoma can develop anywhere on your body. However, it usually develops in places that are the most exposed to sunlight, including your:

• Arms.
• Head (scalp).
• Legs.
• Trunk (torso).

Nodular melanoma is usually larger than moles you might have on your skin. They’re generally greater than 1 centimeter in diameter, which is about the length of a staple, and higher than 6 millimeters, which is about the height of 60 sheets of paper.

What are the symptoms of nodular melanoma?

Symptoms of nodular melanoma include:

• A firm, dome-shaped growth on your skin.
• Discoloration (red, pink, brown, black, blue-black or the same color as your skin).
• Texture may be smooth, crusty or rough, like cauliflower.
• Bleeding.
• Itching.
• Stinging.

Can nodular melanoma look like a blood blister?

Yes, nodular melanoma can look like a blood blister.

Blood blisters develop after something pinches your skin. Blood flows to the area from broken blood vessels and damage to the lower layers of your skin. The blood pools and forms a raised blister, which may look brown, red, black or the same color as your skin.

Does nodular melanoma bleed?

Yes, nodular melanoma may bleed if you poke, scratch or squeeze it. It may also bleed without agitation.

Is nodular melanoma hard or soft?

Nodular melanoma is usually hard or firm to the touch.

What causes nodular melanoma?

The biggest risk factor for developing nodular melanoma is overexposure to ultraviolet (UV) light, especially sunburns.

Your skin contains melanocytes (pronounced “mel-ann-o-sites”). Melanocytes produce melanin, which provides the color (pigment) in your skin. UV exposure from the sun (solar) or tanning beds can cause the DNA in your melanocytes to change. The melanocytes grow and divide uncontrollably and invade nearby tissues (malignancy).

Is nodular melanoma contagious?

No, nodular melanoma isn’t contagious. You can’t give nodular melanoma to another person.

How is nodular melanoma diagnosed?

Your healthcare provider will perform a physical examination of the growth, the skin around your growth and your lymph nodes. They’ll touch (palpate) your growth and may ask a few questions, including:

• When did you first notice the growth?
• Has the growth grown or stayed the same size?
• Does it hurt when I touch it?
• Has the growth changed colors?
• Is the growth itchy or painful?
• Does the growth bleed?
• Have you ever had skin cancer before?
• Do you have a family history of skin cancer?

What tests will be done to diagnose nodular melanoma?

After a physical examination, your healthcare provider may perform a biopsy to confirm their diagnosis. They’ll numb the area so you don’t feel any pain. They may remove a small amount of the growth, or they may remove most or all of it. Then, they’ll send the growth sample to a laboratory so other healthcare providers can test it for cancer cells. You should get the results of your biopsy in two to 10 days.

How is early-stage nodular melanoma treated?

Nodular melanoma treatment depends on the stage and your general health. The priority is to cure your cancer, but your healthcare providers also want to stop your cancer from coming back and maintain your skin’s appearance.

Often, surgery is the first treatment for early-stage nodular melanoma. Depending on your melanoma type, you may have local numbing and be awake during the procedure, or you may be sedated (put under) with general anesthesia during surgery.

Once you’re either numbed or asleep, a dermatologist or surgeon will use a sharp, thin knife (scalpel) to remove the nodular melanoma and some of the healthy skin and tissue surrounding the growth.

How is late-stage nodular melanoma treated?

If you have late-stage nodular melanoma, the cancer has spread to other parts of your body. In addition to surgically removing the nodular melanoma, additional treatments may include a combination of:

• Lymphadenectomy. In a lymphadenectomy (pronounced “lim-fad-nec-toh-me”), your surgeon will remove the lymph nodes near your nodular melanoma. A lymphadenectomy can prevent the cancer from spreading to other areas of your body.
• Internal organ surgery. Your surgeon will remove part of your affected organs to prevent the cancer from spreading to other areas of your body.
• Immunotherapy. Immunotherapy stimulates your immune system to make more cancer-fighting immune cells.
• Targeted cancer therapy. In this treatment option, drugs attack specific cancer cells. The drugs won’t harm your healthy cells.
• Chemotherapy. Your healthcare provider gives you drugs that destroy cancer cells and prevent them from multiplying.

How soon after treatment will I feel better?

It depends on your treatment.

After surgery, your skin should heal in one to three weeks.

After chemotherapy and targeted cancer therapy, most side effects go away after stopping treatment.

How can I reduce my risk of getting nodular melanoma?

The following tips can help reduce your risk of getting nodular melanoma:

• Avoid sun and seek shade, especially between 10 a.m. and 4 p.m. when the sun’s rays are the strongest.
• Don’t use tanning beds. Use a spray tan (cosmetic) instead.
• Wear hats with brims, sunglasses, long-sleeved shirts and pants whenever possible.
• Use a broad-spectrum sunscreen with a skin protection factor (SPF) of 30 or higher. Reapply it often, especially if you’re swimming or sweating.
• Use a lip balm with sunscreen.
• Pay attention to your skin. If you notice any new growths or moles, reach out to your healthcare provider right away.

What can I expect if I have nodular melanoma?

Early diagnosis is extremely important if you have nodular melanoma. When diagnosed in its early stages, your prognosis is good.

However, nodular melanoma grows quickly, and late-stage nodular melanoma can be fatal. Your chances for a full recovery are better the sooner it’s diagnosed and removed.

What is the nodular melanoma survival rate?

The following survival rates reflect the percentage of people who are still alive five years after receiving a nodular melanoma diagnosis and treatment:

• Stage 0, I and II: 98.4%
• Stage III: 63.6%
• Stage IV: 22.5%

When should I see my healthcare provider?

See your healthcare provider if you have any of the following:

• Firm new growths on your skin.
• Growths that change in size, color or shape.
• Growths that itch or bleed.
• A personal history of skin cancer.
• A family history of skin cancer.
• A history of intense sun exposure.

What questions should I ask my healthcare provider?

• How can you tell that I have nodular melanoma?
• What stage of nodular melanoma do I have?
• How big is the nodular melanoma?
• How deep is the nodular melanoma in my skin?
• Has the nodular melanoma spread to other parts of my body?
• What treatment do you recommend?
• What’s the complete list of side effects of each treatment option?
• What are the odds that the nodular melanoma will come back?
• How can I reduce my risk of developing nodular melanoma again in the future?

Can you scratch off nodular melanoma?

No, you can’t scratch off nodular melanoma. The cancer will continue to spread, and you may cause an infection.

A note from Cleveland Clinic

Receiving a nodular melanoma diagnosis can be scary and frustrating. It’s a good idea to pay attention to your skin, especially if you’re fair-skinned or spend a lot of time in the sun. If you notice any changes, reach out to your healthcare provider immediately. They can help you understand your treatment options and what to expect, which can help ease any anxiety.