Nodular melanoma is one of the most common types of melanoma. This type of skin cancer usually causes a dark-colored, raised bump. Nodular melanoma is a very aggressive (fast-growing) type of skin cancer, so it’s important to get a diagnosis as soon as possible.

Nodular melanoma can sometimes look like other skin conditions, and this might make it harder to diagnose. Learning more about the risk factors and symptoms of nodular melanoma can help you recognize it.

Read on to find out how the disease is diagnosed, managed, and more.

What Causes Nodular Melanoma?

Melanocytes are skin cells responsible for making melanin, the pigment that gives the skin its color. Nodular melanoma develops when melanocytes divide too quickly and form a tumor.

Like all cancers, melanoma forms when certain genetic mutations (changes) in the DNA of cells allow them to start growing out of control. These melanoma mutations can happen when too much exposure to ultraviolet (UV) light from the sun or tanning beds damages the DNA. There are also inherited genetic mutations you may get from your parents that put you at a higher risk of developing nodular melanoma.

Problems with your immune system can also raise your risk for melanoma. Normally, your immune system can recognize when cells start to grow out of control and will destroy them before cancer develops. However, some immune conditions make it harder for your immune system to identify and kill cancer cells. This can allow the cells to keep dividing and ultimately form nodular melanoma.

Similarly, some immunosuppressant drugs (for instance, methotrexate) prescribed to treat autoimmune conditions — such as rheumatoid arthritis and psoriasis — have been linked to a higher risk of melanoma, including nodular melanoma.

Risk Factors for Nodular Melanoma

Nodular melanoma is the second most common type of melanoma and makes up about 15 to 30 percent of all melanoma cases. Although anyone can develop nodular melanoma, men and people assigned male at birth who are 50 and up are more likely to be diagnosed, according to Cleveland Clinic.

Other risk factors for nodular melanoma include:

• Having a fair skin complexion
• Spending long periods of time exposed to the sun
• Using tanning beds

Additionally, melanoma can run in the family. If you or other people in your family have had skin cancer before, your chance of getting nodular melanoma goes up.

How Does Nodular Melanoma Differ From Other Types of Melanoma?

The skin lesions (abnormal marks) caused by nodular melanoma usually start by growing deep into the skin instead of spreading out. While nodular melanoma usually causes a dark bump, superficial spreading melanoma — the most common type of melanoma — causes dark, flat skin lesions. Nodular melanoma is also more aggressive and harder to treat compared to superficial spreading melanoma.

Nodular melanoma typically affects people with lighter skin — this differs from acral-lentiginous melanoma, a less common condition that usually affects darker-skinned people.

Unlike most cases of nodular melanoma, amelanotic melanoma and desmoplastic melanoma usually cause skin lesions that have the same skin pigment color as the surrounding skin.

Lentigo maligna melanoma — another type of melanoma — can also cause dark skin lesions, but these are usually flat, rather than nodular.

Symptoms of Nodular Melanoma

Nodular melanoma causes a large, firm bump on the skin that may be much darker than your normal skin color. More rarely, the bump will be the same pigment as your skin.

The skin growth caused by nodular melanoma can feel either smooth or rough to the touch. It can also:

• Bleed easily if you scratch or poke it
• Bleed without being touched
• Be itchy or cause a stinging sensation

Nodular melanoma can form a tumor anywhere on the body, but it usually appears in areas that are more likely to be exposed to sunlight. This can include your:

• Head
• Arms and legs
• Torso

Depending on where the tumor is, nodular melanoma can also cause other symptoms. People with tumors on their torso may have breathing problems that get worse over time. The tumor may also may also be painful for some people, but not others.

Diagnosis of Nodular Melanoma

To diagnose melanoma, your health care provider may start by discussing your personal and family medical history. Since nodular melanoma occurs more often in people with a family history of melanoma or other types of skin cancer, this can help them know if you’re at a higher risk for nodular melanoma.

A dermatologist may also be able to diagnose nodular melanoma by looking at the appearance of the skin growth. They will look for EFG, which stands for:

• E — Elevated (meaning the lesion is raised and not flat)
• F — Firm to the touch
• G — Growing quickly

Nodular melanoma tumors will generally meet all three rules. However, there are other types of skin lesions that can look like nodular melanoma, such as blood blisters or other benign (noncancerous) growths. This can make it difficult to diagnose nodular melanoma just by looking at your skin.

If your doctor thinks you might have nodular melanoma, they may perform an excisional biopsy. To do this, they’ll remove the entire skin tumor and look at it under a microscope. If melanoma cells are found in the sample, they can make a diagnosis of nodular melanoma.

Treatments for Nodular Melanoma

The best treatment option for melanoma depends, in part, on what stage the cancer is. If you have early-stage nodular melanoma that’s limited to the skin, surgery to remove the tumor might be the only treatment you need. People with more advanced disease, however, have cancer cells in the lymph nodes or other parts of the body. In these cases, surgery is generally still used, but other treatments may be needed as well.

Immunotherapy can be useful for treating people with deeper tumors or affected lymph nodes. Immunotherapy drugs help cells of the immune system more effectively identify and destroy cancer cells. Although serious side effects are possible, immunotherapy is one of the most effective therapies for advanced nodular melanoma.

Targeted therapies — or drugs that interact with one specific type of protein — are also used to treat nodular melanoma. Certain targeted therapy drugs may be useful for people whose cancer cells have specific genetic mutations.

Some people may also receive chemotherapy drugs, which can specifically kill cells that divide very quickly. However, because targeted therapies and immunotherapies work better for melanoma, chemotherapy is not used as often — it’s usually reserved for people who don’t respond well to other types of therapy.

Prognosis of Nodular Melanoma

Because nodular melanoma is an aggressive skin cancer that can be hard to diagnose, many people already have advanced disease by the time they see a doctor. This leads to a worse prognosis (outlook) for people with nodular melanoma. More than 40 percent of deaths from melanoma are caused by nodular melanoma.

Fortunately, newer treatments like immunotherapy and targeted therapy are helping more people with nodular melanoma live longer lives. The five-year survival rate for nodular melanoma is about 50 percent to 60 percent. This means that more than half of people with nodular melanoma will likely be alive five years after diagnosis.

When melanoma is treated during the early stages of disease, most people will live for a long time. Therefore, a major part of improving the prognosis for nodular melanoma is finding the disease early. One goal of medical research is to find better strategies for diagnosing nodular melanoma. The earlier you can get diagnosed and start treatment, the better chance you’ll have at a longer, cancer-free life.

Talk With Others Who Understand

MyMelanomaTeam is the social support network for people with melanoma and their loved ones. On MyMelanomaTeam, members come together to ask questions, give advice, and share their stories with others who understand.

Have you or a loved one been diagnosed with nodular melanoma? Share your story in the comments below, or start a conversation by posting on your Activities page.