Skin - Melanocytic tumor
Melanoma
Nodular melanoma

Author: Christopher Hale, M.D. (see Authors page)

Revised: 20 February 2017, last major update May 2013

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Nodular melanoma

Cite this page: Nodular melanoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/skintumormelanocyticnodularmelanoma.html. Accessed February 22nd, 2017.
Definition / General
  • Aggressive subtype of melanoma with early vertical growth phase
Epidemiology
  • Median age 63 years; men > women
Sites
  • Affects all body surfaces, but usually legs and trunk
Clinical Features
  • Screening methods have had little impact on this subtype (Cancer 2008;113:3341); may have less of an association with sun exposure than superficial spreading subtype (Melanoma Res 2012;22:460)
  • 15 - 30% of melanoma patients, but 37% of fatal melanomas (Arch Dermatol 2012;148:30)
  • Rapid growth; comprises 34% of thick (2 mm+) melanomas (Arch Dermatol 2005;141:745)
  • Higher risk for metastases due to vertical growth phase, but differs from "vertical growth melanoma" (J Dermatol 2008;35:643)
  • May recur even in sentinel lymph node negative patients (Surgeon 2006;4:153)
  • Smooth nodule covered by normal epidermis, elevated bluish black plaque or ulcerated polypoid mass
  • Usually no lateral flat component
Case Reports
Dermoscopy
  • Nonspecific global dermoscopic patterns of globules, bluish white veil, atypical vessels and structureless areas (Arch Dermatol 2008;144:1311)
  • Important features: peripheral black dots / globules, multiple brown dots, irregular black dots / globules, bluish white veil, homogeneous blue pigmentation, 5 to 6 colors and black color (JAMA Dermatol 2013;149:699)
Dermoscopic Images

Images hosted on other servers:

Atypical globular pattern (Fig. 1A)

Nonspecific pattern (Fig. 5A)

Clinical Images

Images hosted on other servers:

25 cm tumor

Various Images

Micro Description
  • No radial growth phase
  • Epidermis is thin and may be ulcerated
  • No in situ melanoma
  • Dermal component consists of a cohesive nodule of tumor cells with pushing border
  • Cells are most commonly epithelioid, may be spindled or small with occasional monster cells (Am J Dermatopathol 2005;27:208)
Micro Images

Images hosted on PathOut server:

Contributed by John Irlam, D.O., Department of Pathology, University of Toledo Medical Center:

Low power (4×)

Medium power (10×)


Medium power (20×)

High power (40×)



Images hosted on other servers:

Hyperkeratosis without pagetoid spreading (Fig. 1C)

Noncoalescence atypical melanocytes (Fig. 5B)

Fig. 6B and 6C

Poor differentiation

Ki67 staining

Molecular / Cytogenetics Description
Differential Diagnosis