Nodular melanoma: Patients' perceptions of presenting features and implications for earlier detection

Background: The incidence of thick melanoma and related mortality is largely static despite advances in early detection during the last 20 years. Nodular melanoma (NM) accounts for the majority of thick lesions and is difficult to recognize in the early stages of its evolution. Objective. The purpose of this study was to identify historic or clinical features that may facilitate earlier detection of NM. Methods: A questionnaire was administered to 125 patients attending the Victorian Melanoma Service between 1998 and 2000 with superficial spreading melanoma or NM. Parameters were compared by tumor type and thickness. Results: NMs are more often symmetric, elevated, uniform in color, and nonpigmented. Color change is uncommon. Conclusion: NM often fails to fulfill the ABCD diagnostic criteria. Biopsy after a set period of observation should aid differentiation from inflammatory lesions and enable earlier detection of this subtype.