In detail, nodular melanoma is a malignant tumor that has a high mortality rate, probably because it is difficult to identify and characterized by a "high speed of development. It is, in fact, a skin tumor that manifests itself in a subtle and which could be confused with other skin lesions of a benign nature. Nodular melanoma, however, possesses characteristics and peculiarities that can be useful in the context of diagnosis.
Currently, the treatment involves the removal of the nodular melanoma itself, which can be associated with pharmacological and non-pharmacological anticancer treatments (anticancer chemotherapy, radiotherapy, etc.).
. It is a malignant tumor that can occur at any age and in patients of any sex, although it tends to affect male patients over the age of 50 more frequently.
Although not too common, nodular melanoma has a fair incidence. In fact, it is estimated that this malignant tumor represents about 10-15% of cutaneous melanomas affecting patients belonging to the Caucasian population. However, due to its aggressiveness and subtle development, nodular melanoma has a "high mortality in the first five years of its diagnosis. Not surprisingly, it is responsible for about 40-50% of deaths related to skin melanomas.
specifically, of melanocytes (the cells responsible for the production of the melanin pigment). Following a series of genetic mutations, melanocytes escape the normal mechanisms of cellular regulation, replicating quickly and massively, losing all or almost their function.The reason why these mutations still occur is not entirely clear, but the cause is believed to be multifactorial. In detail, among the possible factors that can favor or expose the patient more to the development of this type of malignant tumor, we remember:
- Genetic predisposition;
- Family history of nodular melanoma or other types of melanoma
- Immunosuppression;
- Presence of autoimmune diseases;
- Exposure to UV rays, clear phototype and the presence of other types of melanocytic nevi, especially atypical or congenital giant (these are possible risk factors on which, however, there are conflicting opinions).
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To tell the truth, unlike what happens for other types of melanoma, the relationship between nodular melanoma and exposure to UV rays is not confirmed. In fact, nodular melanoma seems to occur mainly in people with poor skin photoaging and can arise in sites generally little or no exposure to UV rays. At the same time, it has been noted that this malignant tumor also occurs in people who do not have large quantities of melanocytic nevi. In fact, as will be seen later, in most cases, nodular melanoma does not result from the malignant transformation of a melanocytic nevus, but is a recently formed malignant lesion.
, dome-shaped and usually hard in texture. The color is variable and can be black or dark blue, light brown, or it can take on the color of the skin or, possibly, a reddish-pink tone (in the latter case, we speak more properly of achromic or non-pigmented nodular melanoma) .
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When nodular melanoma is non-pigmented it can be confused with a pimple or an acne lesion and, therefore, does not worry the patient. Unlike a common pimple, however, nodular melanoma does not tend to regress, but rather continues to remain on the skin and increase its size. In addition, pink-reddish nodular melanoma sometimes has a dark pigmented border (defined as "pigment leak"), a clear sign of the melanocytic origin of the lesion. These characteristics should set off the alarm bell in the same patient.
As mentioned, nodular melanoma can occur in areas where there were no lesions of any kind. Therefore, it is not certain that - as happens on some occasions - the malignant tumor derives from a pre-existing melanocytic nevus which evolves towards a malignant form; on the contrary, in many cases, it is a recently formed skin lesion.
However, among the areas most affected by the development of nodular melanoma, we find the head, neck, trunk, arms and legs. Of course, this does not mean that the tumor cannot also manifest itself in other parts of the body.
Development of Nodular Melanoma
Another particular characteristic of nodular melanoma is given by the way it develops. This tumor, in fact, can manifest itself as a newly formed lesion that develops in depth from the earliest stages of growth. Unlike other forms of melanoma that tend to follow a radial growth (ie on the surface of the skin or "oil stain"), nodular melanoma tends to develop little or nothing in the radial sense presenting, instead, a "high growth vertical extensive (that is, towards the deeper parts of the skin, up to the subcutaneous tissue and the blood and lymphatic vessels, from which it can give rise to metastases).
What Features To Pay Attention To?
Given the subtle development and the sometimes "misleading" aspect, the identification of a nodular melanoma or in any case of a suspected lesion capable of prompting the patient to consult a doctor could be difficult. The thing becomes even more complicated if we consider the fact that nodular melanoma does not follow the so-called ABCDE rule as, on the other hand, do other forms of melanoma (for more information: Melanoma).
However, summing up what has been said so far, we can say that the characteristics to pay attention to and which can lead to suspect the presence of a nodular melanoma, are:
- Dome shape with generally regular edges;
- Black or dark blue, brown or reddish-pink color;
- Hard consistency;
- Very fast development and growth;
- Tendency to remain on the skin and not to regress in a few days as can happen, however, for pimples and boils.
With the progress of growth, however, the malignant lesion can give rise to a symptomatology considered typical and characterized by ulceration and bleeding. However, it should be noted that similar symptoms do not occur in all patients and that, in some cases, the lesion could remain asymptomatic.
Complications of Nodular Melanoma
The most troubling complication of nodular melanoma is metastasis. In fact, due to the high speed with which it expands and invades the skin tissues, the nodular melanoma is able to reach the underlying blood and lymphatic vessels favoring the entry into the blood or lymphatic circulation of the cancer cells that compose it even before is diagnosed.
in order to determine the malignant nature of the formation in question.In the event of a suspected lesion, the dermatologist may recommend immediate removal of the same (without going through the biopsy) which is followed by a histological examination of the removed tissue.
At the same time, it is possible to perform a biopsy of the lymph nodes in order to assess the presence of a "possible metastasis (sentinel lymph node technique; for more information: Melanoma - Diagnosis and Treatment).
Differential diagnosis
The differential diagnosis of nodular melanoma should be made against other benign lesions - such as dermatofibroma, seborrheic keratitis lesions or pyogenic granuloma - and against other malignant forms, such as basal cell carcinoma.
nodular depend essentially on the stage at which the tumor is located.
Undoubtedly, the first step consists in the surgical removal of the nodular melanoma, followed by the analysis of the same. Depending on the size of the lesion removed and the depth reached, the doctor is able to establish the stage of the tumor and the consequent therapeutic strategy to be If the thickness of the lesion is greater than one millimeter, usually, a biopsy of the lymph nodes is also performed.
The other treatments that can be undertaken in the presence of nodular melanoma are anticancer chemotherapy (exploits the use of anticancer drugs) and radiotherapy (exploits the action of radiation beams or ionizing particles to eliminate malignant tumor cells).
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