What Is Nodular Melanoma?

Nodular melanoma is a fast-growing, aggressive form of skin cancer that can grow into the deeper layers of the skin quickly if not removed.

It is the second most common kind of melanoma. Even so, nodular melanoma makes up just 14% of all melanomas. However, this type of melanoma is responsible for more than 40% of melanoma deaths. This is due to how fast it can grow.

Learn more about nodular melanoma, causes, symptoms, treatments, and prognosis.

Doctor exam for skin cancer


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Nodular Melanoma Symptoms

Nodular melanoma most commonly appears on exposed areas of skin like the head and neck but may appear anywhere on the skin.

Visually, nodular melanomas appear as small lumps on the skin that grow rapidly over weeks or months.

The lump may be:

  • Dome-shaped
  • Firm
  • Typically larger than a centimeter in diameter at the time of diagnosis
  • Itchy
  • Stinging
  • Black, white, reddish, or blueish in color
  • Smooth
  • Rough
  • Crusted
  • Warty
  • Bleeding
  • Oozing

Notably, nodular melanomas tend to be fast-changing in shape, color, and size. For instance, bumps may go from round to oblong, or reddish to dark brown over a period of two weeks to a month.

Nodular melanoma also does not meet the ABCDE criteria of warning signs of melanoma. These warning signs include:

  • Asymmetry
  • Border irregularity
  • Color variation/change
  • Different
  • Evolving

The acronym EFG is used to help identify skin changes that may be indicative of nodular melanoma. These include:

  • Elevated
  • Firm
  • Growing

Causes

Like all melanomas, nodular melanoma is caused by mutations in a form of skin cells called melanocytes. These cells make melanin, which is the pigment that determines skin color.

When melanocytes grow out of control, they form tumors.

What triggers the melanocytes to mutate is unknown, but is believed to be due to changes to DNA.

There are several risk factors for developing nodular melanoma. These include:

  • Spending time in the sun
  • Spending time in tanning beds
  • Older age
  • Atypical or many moles
  • Large birthmarks
  • Family history of melanoma
  • Light complexion

Diagnosis

Because nodular melanoma tends to grow aggressively, it is important to get this type of skin cancer diagnosed early so treatment can begin as soon as possible.

A doctor may use a number of tests to reach a diagnosis of nodular melanoma.

These include:

  • Dermoscopy. A doctor will use an instrument that both magnifies and illuminates (called a dermatoscope or dermoscope) to exam the skin. This allows the physician to see structures not visible to the naked eye as well as note the size, shape, and color of areas suspected of being nodular melanoma.
  • Skin biopsy. A small piece of tissue from the affected area will be removed and sent to a lab for analysis under a microscope to determine if the lump is cancerous.
  • Excision biopsy. If the lesion is suspected a nodular melanoma, a doctor will numb the area with local anesthesia and use a surgical knife to cut the whole lump or lesion to be sent to the lab for testing.

Once melanoma has been diagnosed a doctor may order additional tests to check if the cancer has spread to other parts of the body. These include:

Treatment

Treatment of nodular melanoma is focused on curing cancer, preserving skin appearance, and stopping cancer from returning.

If found early, nodular melanoma can be cured. However, nodular melanoma can grow quickly and is often diagnosed at an advanced stage. Treatment will most often involve surgery to remove the melanoma.

During surgery, the nodular melanoma, as well as some surrounding areas of skin will be removed.

If cancer is found to have spread to lymph nodes nearby, these will also be removed in surgery.

If the cancer has spread to other organs in the body, other treatments may be necessary. These include:

  • Chemotherapy
  • Radiation
  • Immunotherapy
  • Targeted therapy
  • Surgery
  • A combination of the above

Prognosis

Nodular melanoma is a fast-growing, aggressive form of skin cancer and because of this, it may not be diagnosed until the cancer is advanced. This may affect treatment and prognosis. It may also mean the cancer can spread to other parts of the body before it is found.

The 5-year survival rate for all forms of melanoma skin cancer varies based on how far the cancer has spread.

The table below shows the 5-year survival rates for melanoma skin cancer at various stages.

5-year survival rate for all melanoma skin cancers
Stage 5-year survival rate
Localized (meaning the cancer hasn't spread) 99%
Regional (meaning the cancer spread to nearby lymph nodes or organs) 66%
Distant (meaning the cancer has spread to other parts of the body) 27%
All stages combined 93%

Coping

Receiving a diagnosis of skin cancer can be challenging emotionally as well as physically.

The American Cancer Society offers resources and tips for coping with a cancer diagnosis. These include:

  • Reaching out to family and friends for help
  • Seeking professional help if feelings of sadness or hopelessness persist
  • Staying active
  • Eating well-balanced meals
  • Doing things you enjoy
  • Not giving up healthy habits
  • Talking about your feelings
  • Getting help with everyday tasks if necessary

Support groups

Joining a support group may be helpful for people dealing with a skin cancer diagnosis. Groups may meet online or in-person and are an opportunity to interact with others in a similar position.

In a support group you may:

  • Share your fears and concerns
  • Learn how others in a similar situation have coped
  • Learn how to deal with your emotions
  • Learn how to cope with side effects of treatments
  • Learn to cope with family issues
  • Learn how to handle work or money issues while ill

Support groups can be organized based on the type of cancer, treatments, gender, age, or other factors.

Support groups could be led by:

  • Oncology social workers
  • Psychologists
  • Oncology nurses
  • Cancer survivors

To choose the right support group, you may consider:

  • Where and when meetings are held
  • If the group is online or in-person
  • Who the group is designed for
  • Number of members
  • Who leads it
  • Whether the group is educational or supportive based
  • Whether you have to speak, or whether you can just listen

It may take visiting a few groups to find the best fit.

A Word From Verywell

Nodular melanoma is the second most common form of melanoma. It is a fast-growing, aggressive form of skin cancer. If found early, it can be cured, so it's important to have any questionable moles, lesions, or bumps checked out by a medical professional. Early diagnosis and treatment will give you the best chance of making a full recovery.

If you are diagnosed with nodular melanoma, remember that treatment options are available and many people live a long, healthy life after their diagnosis.

Treatment often includes surgery and, if the cancer has spread, may require further treatments like chemotherapy. Don't hesitate to find a support group or counseling, which may be beneficial in navigating the psychological toll of dealing with a cancer diagnosis and treatment.

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10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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