nodular melanoma

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Introduction

Second most common of tumors that arise in melanocytes of individuals with white skin.

Etiology

(risk factors)

Epidemiology

Pathology

Clinical manifestations

  • uniformly elevated nodule or ulcerated thick plaque
  • may be reddish-blue (purple) or blue-black; either uniform in color or mixed with brown or black
  • may become polypoid & amelanocytic (pink) or tan
  • early lesions are 1-3 cm, but may grow much larger if undetected initially
  • oval or round with regular borders in contrast to other melanomas
    • most nodular melanomas are smooth, but others are eroded, portending poor prognosis
  • distribution: upper back (most common), legs, anterior trunk (same as superficial spreading melanoma), on arms & legs in Japanese
  • arises within 2-4 months to 2 years from normal-appearing skin or a melanocytic nevus

Laboratory

  • excisional biopsy with narrow margins
  • punch biopsy is acceptable when total excision is not feasible or impractical

Complications

Differential diagnosis

Management

(same for superficial spreading & acral melanoma):

More general terms

Additional terms

References

  1. Color Atlas & Synopsis of Clinical Dermatology, Common & Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 202-203
  2. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 544
  3. 3.0 3.1 3.2 Mar V et al. Nodular melanoma: A distinct clinical entity and the largest contributor to melanoma deaths in Victoria, Australia. J Am Acad Dermatol 2012 Nov 21 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23182058
  4. 4.0 4.1 Pottegard A, Pedersen SA, Schmidt SAJ et al Association of Hydrochlorothiazide Use and Risk of Malignant Melanoma. JAMA Intern Med. Published online May 29, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29813157 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2682616