How Nodular Melanoma Is Diagnosed

Nodular melanoma may first be noticed during a self-skin check at home or an annual skin check by your dermatologist or healthcare provider.

If nodular melanoma is suspected, your healthcare provider will take a full medical history, examine the skin, and take a skin biopsy to reach a diagnosis.

Other tests, such as an X-ray and MRI, may be necessary depending on whether or not the nodular melanoma has spread.

This article will review how nodular melanoma is diagnosed.

Self-Checks/At-Home Testing

The majority of melanomas are first found through at-home skin checks either by the person with melanoma or their family members.

Self-skin checks are an important method for identifying melanoma. Finding skin cancer early gives the best chance for successful treatment.

Most doctors advise checking your skin at least once a month for any changes or suspicious marks.

It is particularly important for those with a higher risk of skin cancer to conduct regular at-home skin checks. Those with a higher risk for skin cancer include:

• People with a family history of skin cancer
• People who have previously had skin cancer
• People with lowered immunity

An at-home skin check is best conducted:

• In a room that is well lit
• In front of a full-length mirror

It may be helpful to enlist a trusted family member or friend for help in seeing the back of your body. You can also use a handheld mirror to see areas that are difficult to examine, like the back of the thigh or scalp.

The first time you do an at-home skin check:

• Examine the entire surface of your skin.
• Take note of existing moles, freckles, marks, and blemishes on the skin.
• Tell your healthcare provider about any areas of concern.

Taking note of existing marks and moles during your first skin exam will give you a reference point for future skin checks, so you can notice if any mark has changed in shape, size, or color.

To perform an at-home skin check, follow these steps:

1. Stand in front of a mirror.
2. Examine your face, neck, ears, chest, and stomach.
3. Women should lift their breasts to check the skin underneath.
4. Raise your arms and check the armpits.
5. Examine both sides of the arms.
6. Check the palms and tops of your hands, not forgetting in between the fingers and under the fingernails.
7. Sit down.
8. While sitting, examine the front of the thighs, as well as your shins and tops of your feet.
9. Don’t forget to look between your toes and underneath your toenails.
10. Using a hand mirror, check your calves, the backs of the thighs, and the bottoms of the feet.
11. Use the hand mirror to examine the genital area, the buttocks, and the lower and upper parts of the back.
12. Use the mirror to check the back of the neck, as well as the ears.
13. Use a comb and part your hair to examine your scalp.

If you see anything that concerns you, make an appointment to see your healthcare provider or a dermatologist.

It is important to remember that unlike other melanomas, nodular melanoma does not fit the ABCDE criteria of skin cancer diagnosis:

• Asymmetry
• Border irregularity
• Color variability or change
• Different
• Evolving

Instead, this type of skin cancer follows the EFG acronym for identifying nodular melanoma:

• Elevated
• Firm
• Growing

Physical Examination

To make a diagnosis of nodular melanoma, a healthcare professional will first take a complete medical history and conduct a full physical examination of your skin.

Before your appointment:

• Make a note of any moles or marks that concern you.
• Remove all makeup.
• Take off bandages or anything else that covers the skin.
• Remove jewelry.

Here’s what to expect during a skin exam:

• You will be asked to remove your clothes and wear a gown.
• The doctor will methodically examine every part of your skin from the head to the toes.
• The healthcare provider may use a handheld tool with a light and magnifier (called a dermatoscope) to closely examine marks on the skin.
• The healthcare professional will note size, shape, texture, and color of areas of concern.
• They will note if any lesions are crusting, oozing, or bleeding.
• If nothing suspicious is found, the exam should be short.
• If something suspicious is found, the healthcare provider will likely perform a skin biopsy—a test where a sample of tissue is removed from the lesion and sent to a lab for testing.

Labs and Tests

If a suspicious mark or lesion is found during a physical exam, a doctor or other healthcare professional will take a skin biopsy. During this procedure, the affected area is numbed with a local anesthetic (which is usually injected with a needle), then a piece of the lesion is removed and sent to a lab to be studied under a microscope.

Different types of biopsies may be done, depending on the size and depth of the lesion. These may include:

• Shave biopsy: In this type of biopsy, a thin slice of the mark or lesion is shaved off with a surgical knife.
• Punch biopsy: This procedure involves a cookie cutter-like device that cuts through all the layers of skin to remove a deeper sample of tissue.
• Excisional biopsy: If a nodular melanoma is suspected, the doctor may use this type of biopsy, which involves removing the entire growth as well as a small amount of normal tissue surrounding it. Due to nodular melanoma’s fast-growing nature, this is often the preferred biopsy for this type of skin cancer.

Biopsy samples are sent to a lab to be examined under a microscope. A pathologist will determine whether cells are cancerous and what type of cancer cells they are.

If results are inconclusive, other lab tests may be performed to confirm a diagnosis of nodular melanoma.

These lab tests, which look for specific DNA markers that can help your healthcare team determine the best course of treatment, may include:

• Gene expression profiling (GEP)
• Comparative genomic hybridization (CGH)
• Immunohistochemistry (IHC)
• Fluorescence in situ hybridization (FISH)

Blood tests aren’t typically used to diagnose melanoma, but blood may be tested before or during treatment for melanoma.

Imaging

A number of imaging tests may be used to look at whether the nodular melanoma has spread in the body, and if cancer has spread to lymph nodes or other organs.

Possible imaging tests include:

• X-ray
• Computer tomography (CT) scan
• Ultrasound
• Magnetic resonance imaging (MRI) scan
• Positron emission tomography (PET) scan

These imaging tests are typically not necessary in the earliest stages of melanoma.

Differential Diagnosis

Reaching a diagnosis of nodular melanoma involves testing that may also rule out or diagnose other diseases and conditions, as well as other forms of cancer.

A differential diagnosis is a method that involves distinguishing a specific condition or disease from others that have a similar presentation.

A differential diagnosis of nodular melanoma can include:

• Basocellular carcinoma (BCC)
• Squamous cell carcinoma (SCC)
• Seborrheic keratosis
• Other forms of melanoma
• Inflammatory lesions
• Pyogenic granuloma

A Word From Verywell

Nodular melanoma is a fast-growing, aggressive form of skin cancer. It can be identified at home through self-skin checks, and a diagnosis can be confirmed via a physical examination of the skin and a skin biopsy.

In some cases, other tests like an X-ray and MRI may be used to determine if an advanced melanoma has spread to other parts of the body like the lymph nodes and other organs.

Early detection of melanoma is an important factor in the success of treatment, so doctors recommend regularly checking your skin to look for any new growths or unusual changes in existing marks or moles, or anything else suspicious.

If you are concerned about your skin, you should speak with your healthcare provider as soon as possible.