Skin melanocytic tumor


Nodular melanoma

Topic Completed: 1 May 2013

Minor changes: 8 November 2021

Copyright: 2002-2022,, Inc.

PubMed Search: Nodular melanoma

Christopher S. Hale, M.D.
Page views in 2021: 5,175
Page views in 2022 to date: 248
Cite this page: Hale CS. Nodular melanoma. website. Accessed January 17th, 2022.
Definition / general
  • Aggressive subtype of melanoma with early vertical growth phase
  • Median age 63 years; men > women
  • 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
  • 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

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25 cm tumor

Microscopic (histologic) 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)
Microscopic (histologic) images

Contributed by John Irlam, D.O.

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
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