Nodular melanoma (NM) stands as the second most common subtype of melanoma. Unlike other subtypes, it is characterized by early vertical growth rather than the typical initial radial growth of most melanomas. And thus, it is a clinically more aggressive phenotype. 

Its more aggressive nature and intrinsic ability to mimic benign lesions have prompted clinicians to better evaluate, diagnose and treat NM in earlier stages.  

Clinicians should be aware of its variable presentation and must maintain caution during evaluation. Dermoscopy may help in diagnosis as certain features have been recently explained; however, excisional biopsy should be undertaken in any suspicious lesion as NM possess a significantly worse prognosis when compared to other subtypes of melanoma. Excisional biopsy is crucial for establishing a definitive diagnosis, with AJCC and NCCN guidelines delineating staging criteria and definitive treatment options. 

The gold standard of NM therapy is surgical excision with wide margins; however, an emphasis on early detection, diagnosis, staging and treatment needs to be stressed among clinicians due to its dismal prognosis in later stages, then other subtypes. 

Further research is warranted to outline NM-specific survival outcomes with new adjuvant therapy regimens.

Source: Hernandez LE, Frech FS, Mohsin N, et al. Nodular melanoma: a review of pathogenesis, presentation, diagnosis, and treatment. J Dermatol Skin Sci. 2021;3(3):25-30.