Nodular melanoma: symptoms, what it looks like, diagnosis and treatment

Many people have been told to look for changing moles, but nodular melanoma often does not start as a flat mole. Melanoma Focus describes a raised, nodular lesion with irregular patches of colour and an irregular border, which may bleed or ooze. It adds that some nodular melanomas have no pigmentation, and NHS inform says nodular melanoma is more likely to become red rather than black as it grows.

The NHS lists general melanoma signs that still apply: a mole with an uneven shape or edges, a mix of colours, a large mole (more than 6mm wide, though sometimes smaller when found early), and a mole that changes over time. Other signs include being swollen, sore, bleeding, itchy or crusty. Cancer Research UK adds that most melanomas do not give symptoms such as pain or itching, and that a lump on the skin that lasts longer than a few weeks should be seen.

Because nodular melanoma is raised and may look like a spot, a lump or even a bleeding pimple that does not heal, the useful question is whether a new mark has appeared and is not going away or is getting bigger, rather than whether an old mole has changed.

Melanoma, also called malignant melanoma, is a cancer that usually starts in the skin and develops from melanocytes, the cells that make the pigment melanin. NHS inform lists 4 main types of skin melanoma: superficial spreading, nodular, lentigo maligna and acral lentiginous. Nodular melanoma is the second most common.

What sets nodular melanoma apart is how it grows. Superficial spreading melanoma typically grows slowly outwards across the surface at first. Melanoma Focus says nodular melanoma develops more rapidly and quickly grows downwards into deeper layers of the skin. That vertical growth is why it can be more serious by the time it is found, and why speed of assessment matters.

The NHS says that at the GP appointment you will be asked about your health, family history and symptoms, and the GP will look at the mole and other areas of affected skin. They may photograph it to send to a dermatologist, which is called teledermatology. If the GP thinks symptoms could be cancer, you may get an urgent referral, which the NHS stresses does not definitely mean you have cancer.

NHS inform says you should be seen at the hospital within 2 weeks. The dermatologist uses a dermatoscope and checks the rest of your skin and nearby lymph nodes. If melanoma is suspected, the lesion is removed completely by an excision biopsy so it can be examined. Tests on the lymph nodes may follow, including sentinel lymph node biopsy and ultrasound, with CT, PET-CT or MRI scans if it has spread to the lymph nodes. Tests on the melanoma cells may look for gene changes, which tell the cancer team which targeted or immunotherapy drugs are likely to work if needed.

Staging, which looks at the size and position of the melanoma and whether it has spread, guides treatment, and a multidisciplinary team (MDT) discusses the best plan. NHS inform says most people have surgery to remove more tissue from the area where the mole was removed, called a wide local excision, with the aim of removing all cancer cells. For early melanoma, which means the cancer cells are only in the skin, this is often the only treatment needed.

If melanoma has spread to nearby lymph nodes, your doctor will discuss the best way of treating this, which could include regular ultrasound monitoring as one option. Melanoma that has spread further is treated with other approaches, guided by gene testing, and NHS inform signposts to Macmillan Cancer Support for detail on recurrent and advanced melanoma.

The biggest risk factor for melanoma in general, according to NHS inform, is exposure to ultraviolet light from sunlight or sunbeds, and in the UK there are about 16,700 people diagnosed with melanoma each year. Melanoma is more common in older people but is also found in younger people in their teens and 20s more often than some other cancers.

The sources read do not give separate risk figures for nodular melanoma, so it is best to apply the general advice: protect skin from UV, avoid sunbeds and check your skin regularly, asking someone to look at areas you cannot see. The NHS suggests using a mirror or asking a partner or friend to check.

The NHS says to see a GP if you have a mole that has changed size, shape or colour, is painful or itchy, is inflamed, bleeding or crusty; a new or unusual mark that has not gone away after a few weeks, including on the palms or soles; or a dark area under a nail not caused by injury. For a lump that is growing quickly, do not wait to see whether it settles. Take a photograph to track changes, as NHS inform suggests, and see a GP promptly.

On the NHS you can see a GP, who looks at the mark and may photograph it to send to a dermatologist (teledermatology). If the GP thinks it could be cancer you may be referred urgently, which the NHS says does not definitely mean you have cancer, and NHS inform says you should be seen at the hospital within 2 weeks.

The mark is removed by excision biopsy and examined, and a multidisciplinary team (MDT) discusses the best plan. Some people also arrange a private skin check or mole mapping; any suspicious lesion should still go through the NHS or private dermatology and histology route described above rather than being left to monitor.