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Melanoma Explained

Nodular melanoma: the symptoms & how to spot it—plus survival rates

Nodular melanoma can look like a pimple, blister, insect bite, or other common skin lesions. This is why it can often be overlooked.
A melanographer examines a mole on a patient's neck, assessing it for signs of nodular melanoma
April 12, 2024
8 minutes

Nodular melanoma is one of the four main types of melanoma skin cancer. It is the second most widespread type of melanoma—accounting for around 10-15% of all new melanoma skin cancers. In this post you’ll find nodular melanoma images to help spot the warning signs. Plus, find out about the different stages and survival rates for nodular melanoma. 

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What is nodular melanoma?

Nodular melanoma is a skin cancer that develops quickly. It can grow deeper into the skin within weeks or months. Most skin cancers tend to expand on the outer layer of the skin (epidermis). Nodular melanoma is a little different. It grows above and below the skin, but much of the cancer is in the lower layer of the skin (dermis). Because of its invasive nature, it’s important to detect early-stage nodular melanoma. This is when skin cancer is easiest to treat. 

Nodular melanoma is the second most common type of melanoma skin cancer. Only superficial spreading melanoma is more common. Nodular melanoma is most often diagnosed in those over the age of 65.

What does it look like? (See nodular melanoma photos)

Usually, nodular melanoma appears as a raised, firm lump on the skin. It may be pink, red, brown, black, or blue-black. There are even skin coloured nodular melanoma. The surface on the lesion can be smooth, shiny, or crusted. 

The main characteristics of nodular melanoma are:

  • A rapidly growing lump on the skin
  • Dome-shaped, firm, and usually symmetrical nodule
  • Most often black, red, or skin coloured (can also be varied in colour)
  • May have a smooth, rough, or crusted surface
  • May bleed, itch, or sting

A key point to remember is that nodular melanoma doesn’t always adhere to the same rules of other types of skin cancers. The usual skin cancer warning signs may not apply. For example, asymmetry, border irregularity, colour variation, and large diameter. And, because much of the melanoma may be under the skin, nodular melanoma symptoms may not be visible to the naked eye.

Images of nodular melanomas.
Nodular melanoma appears as a raised, firm lump on the skin. It may be pink, red, brown, black, or blue-black. The surface on the lesion can be smooth, shiny, or crusted.

Nonetheless, these nodular melanoma pictures may assist you to detect this particular type of melanoma.

Pictures of nodular melanoma.
It is important to remember that because much of the melanoma may be under the skin, nodular melanoma symptoms may not be visible to the naked eye.

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What are the stages of nodular melanoma?

Nodular melanoma stages refer to the size/thickness of the lesion and whether the melanoma has spread from its original site. In early stage nodular melanoma (also known as in situ and stage 0 melanoma), cancer cells are detected in the epidermis. It has not spread from the original site in the skin. Yet, if undetected or untreated, nodular melanoma may progress to the following stages:

Stage 1 nodular melanoma

Nodular melanoma stage 1 refers to a thin melanoma (less than 2mm thick) that shows no sign of spreading (metastasis).

Stage 2 nodular melanoma

The nodular melanoma is more than 2mm in thickness. There is no evidence of spreading (metastasis).

Stage 3 nodular melanoma

Nodular melanoma has spread to nearby lymph nodes.

Stage 4 nodular melanoma

The nodular melanoma has spread to distant lymph nodes or skin.

Diagnosis, treatment & survival rates

In most instances a physical skin check, followed by a biopsy will determine the presence of nodular melanoma. A biopsy is a common procedure to remove cells or tissue for further investigation by a medical pathologist. 

If nodular melanoma is diagnosed, it is treated similar to other melanomas. Skin cancer treatment depends on the stage of the cancer. Yet, as nodular melanoma is an aggressive form of skin cancer, it may require more than surgery.

Skin cancer treatment can involve targeted therapy, immunotherapy, chemotherapy, radiation — or a combination of treatments. 

  • Targeted therapy used medication to block the growth of cancer by intercepting certain gene mutations in the melanoma cells. 
  • Immunotherapy uses medicines to help the body's natural defence system (immune system) to find and destroy the cancerous cells. 
  • Radiation therapy for nodular melanoma directs high-energy rays at the tumour. This destroys the cancer cells by damaging their DNA.
  • Chemotherapy is used for advanced stages of melanoma skin cancer. It uses anti-cancer (cytotoxic) medicines to destroy the cancerous cells. 

The aim of treatment is to cure the cancer, preserve the health of your skin, and 

prevent skin cancer recurrence. The good news is that the outlook (prognosis) for early stage nodular melanoma is positive.

Providing the nodular melanoma has not spread at the time of treatment, the survival rate is around 98%. For later stage nodular melanoma, where thickness is more than 4 mm, survival rate is approximately 50%.

Senior couple jogging happily outdoors wearing sun protecting long sleeves.
Nodular melanoma is more common in men, compared to women. Most people who develop this type of skin cancer are over the age of 50 years. It is also less closely linked to sun exposure than other types of melanoma although overexposure to ultraviolet (UV) light is still a risk factor.

Who’s at risk of nodular melanoma?

Nodular melanoma is more common in men, compared to women. Most people who develop this type of skin cancer are over the age of 50 years.  Like most skin cancers, overexposure to ultraviolet (UV) light is a risk factor. Sunburn can cause skin cells (melanocytes) to grow uncontrollably and mutate, leading to skin cancer. Yet, nodular melanoma is less closely linked to sun exposure than other types of melanoma. This includes superficial spreading and lentigo maligna. 

Other risk factors for nodular melanoma include:

  • Having very light/fair skin (Although it can occur on darker skin too)
  • A family history of nodular melanoma or other skin cancers
  • Personal history of skin or other cancers
  • Increasing age

Image of a young lady performing a self skin check.
Regular skin checks are a great way to check for nodular melanoma and other melanoma symptoms. Dermoscopic imaging is advisable to look below the surface of the skin.

Preventing nodular melanoma

Pay attention to your skin. Regular skin checks are a great way to check for nodular melanoma and other melanoma symptoms. Dermoscopic imaging is advisable to look below the surface of the skin. 

Protecting your skin against the sun’s UV rays is also important. The following actions can help keep your skin safe:

  • Apply a broad-spectrum sunscreen (ideally SPF 50+) daily
  • Reduce sun exposure when the UV index is 3 or higher (typically between 10am and 3pm)
  • Seek shade and wear sun protective clothing and accessories (wide-brimmed hat and sunglasses) 

Given the aggressive (quickly growing) nature of nodular melanoma, regular skin checks play an essential role in early detection. At MoleMap all our services include dermoscopic (under the skin) imaging to see signs of skin cancer not visible to the naked eye.

Full Body MoleMap is our most comprehensive skin check. It includes a thorough skin assessment with dermatologist diagnosis, total body photography, additional dermoscopic imaging of moles that may be at risk, and unlimited free spot checks for 12 months.

Skin Check is ideal if you’ve spotted a new or suspicious mole or lesion. A melanographer (a nurse trained in skin cancer detection and triage) will examine your skin. Any dermoscopic images will be sent for further review and dermatologist diagnosis. 

Compare our services and find your nearest MoleMap location. Ultimately, the most important action you can take is to give your skin the attention it deserves.

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MoleMap specialises in skin cancer detection, diagnosis, proactive monitoring and treatment. Want the best protection against melanoma and other skin cancers? Get your skin and moles checked early and often at a MoleMap skin cancer clinic.