Nodular melanoma (NM) is second in frequency (14%) after superficial spreading melanoma (SSM) in most series, occurring largely in middle life in persons with white skin and, as in SSM, on the less commonly exposed areas. The tumor from the beginning is in the "vertical growth" phase and could appropriately be called a deeply penetrating melanoma (as opposed to SSM). NM is uniformly elevated and presents as a thick plaque or an exophytic, polypoid or dome-shaped lesion. The color pattern is usually not variegated, and the lesion is uniformly blue or blue-black or, less commonly, can be very lightly pigmented or nonpigmented (amelanotic melanoma) and confused with a pyogenic granuloma or other nonpigmented tumors. NM is the one type of primary melanoma that arises quite rapidly (4 months to 2 years) from normal skin or from a melanotic nevus as a nodular (vertical) growth without an adjacent epidermal component, as is always present in SSM and LMM.
Both SSM and NM occur in approximately the same sites (upper back in males, lower legs in females), and presumably the same pathogenetic factors are operating in NM as were described in SSM. For the growth pattern of NM. The reason for the high frequency of NM in the Japanese is not known.
NM usually occurs on sun-exposed areas like the head (scalp in men), neck, trunk, arms and legs but can arise anywhere. It is more frequent in males than females, most common during middle age, and generally doesn't grow from an existing mole starting instead as a new growth of its own.
Growth is rapid both below and above the skin frequently achieving a visible diameter of 1-2 cm or larger. Because of this, they are easy to notice, often resembling a blood blister. Unfortunately, most people wait an average of nine months to have a lesion checked. NM grows in weeks to months, not months to years.
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