Nodular Melanoma

I thought I’d post a nodular melanoma I saw yesterday, as this subtype is particularly sinister.  Reportedly 1 in 5 cases of nodular melanoma is ultimately fatal, compared with 1 in 19 cases of superficial spreading melanoma.  There is a nice recent review of the SEER registries statistics regarding this subtype in the Archives of Dermatology.  Another free-text review is available from the journal Cancer.

This nodular melanoma presented as a small slightly pigmented nodule on the upper lip. The patient came in for unrelated reasons. The dermatologist noticed the nodule, which was adjacent to a small pigmented macule and scar from a previous biopsy of the macule years ago (the patient recalled it was benign).  The pigmented macule was biopsied to rule out lentigo maligna with suspicion that the nodule might represent invasive melanoma, although clinically it appeared more like a basal cell carcinoma.  The nodule was indeed a nodular melanoma, but the pigmented macule turned out to be a seborrheic keratosis. This tumor was caught earlier than many I have seen, as they tend to proliferate rapidly.

References

  1. The Contribution of Nodular Subtype to Melanoma Mortality in the United States, 1978 to 2007. Waqas R. Shaikh, BS; Michael Xiong, BA; Martin A. Weinstock, MD, PhD. Arch Dermatol. Published online September 19, 2011.
  2. Factors related to the presentation of thin and thick nodular melanoma from a population-based cancer registry in Queensland Australia.  Geller AC, Elwood M, Swetter SM, Brooks DR, Aitken J, Youl PH, Demierre MF, Baade PD.  Cancer. 2009 Mar 15;115(6):1318-27.
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2 responses to “Nodular Melanoma

  1. Beautifully imaged case. Were there many mitoses? There was certainly no maturation in depth. The statistics on the stable high death rate from nodular melanoma will only improve if we can pick these lesions up earlier. The Australian paper you quoted suggests that regular screening examination offers the best chance of picking these up and making a difference.

    • Thanks. Yes, I counted 7/mm2. There is one in the higher magnification photos I believe. Thorough screening examination was helpful in this case, as it was a good pickup by the dermatologist. The patient came worried about a different lesion altogether and this one would have grown much worse.

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