Melanoma is the most severe form of skin cancer, arising from pigment-producing cells called melanocytes. Nodular Melanoma (NM) is a particularly aggressive variant that often presents differently than common types, frequently leading to delayed detection. NM is concerning due to its rapid growth and tendency to quickly invade deeper skin layers. Understanding NM’s unique symptoms, including its propensity to bleed, is important for early identification.
What is Nodular Melanoma
Nodular Melanoma is the second most common type of melanoma, accounting for 15% to 20% of all cases. It is characterized by an aggressive growth pattern. Unlike Superficial Spreading Melanoma, NM begins its invasion downward almost immediately, leading to a rapid vertical growth phase. This allows the lesion to quickly penetrate the dermis, meaning a seemingly small lesion can be quite deep beneath the surface. NM often presents as a dome-shaped, raised lump and can appear anywhere on the body.
Why Nodular Melanoma May Bleed
The tendency of Nodular Melanoma to bleed is a common and noticeable feature, often occurring spontaneously or after minor irritation. This bleeding results from the tumor’s aggressive structure and rapid growth. As the cancer grows quickly, the tumor and overlying skin can outgrow their blood supply, leading to tissue death (necrosis) and subsequent ulceration.
Ulceration causes the nodule’s surface to break open, forming a fragile sore prone to oozing or bleeding. Because NM lesions are elevated and protrude above the skin, they are physically vulnerable to friction from clothing or accidental bumps. This combination of a fragile, ulcerated surface and raised position makes the lesion highly susceptible to trauma. Bleeding, crusting, or oozing is a significant warning sign that the lesion is rapidly evolving and often indicates a thicker, more advanced tumor.
Identifying Other Key Features
Nodular Melanoma often does not fit the common ABCDE (Asymmetry, Border, Color, Diameter, Evolution) criteria used for other melanomas. Instead, the EFG rule is more applicable for identification.
The EFG Rule
The E stands for Elevation, meaning the lesion is noticeably raised above the surrounding skin, giving it a dome-shaped appearance. This elevation results from the tumor’s vertical growth pattern. The F represents Firmness, indicating the nodule feels solid or hard to the touch, distinguishing it from benign lesions. The final feature, G, is Growth, referring to a rapid change in size over a short period, typically weeks to months. NM may appear uniformly dark brown or black, or sometimes be amelanotic (lacking pigment), appearing pink, red, or skin-colored. A new or changing lump exhibiting these EFG characteristics is highly suspicious.
Immediate Steps to Take
If a person notices a new or changing skin growth that is elevated, firm, or growing quickly, immediate professional evaluation is necessary. Any lesion that begins to bleed, weep, or crust without a clear reason should be considered highly suspicious for Nodular Melanoma. Prompt consultation with a dermatologist or healthcare provider is paramount due to NM’s potential for early deep invasion.
The diagnostic process begins with a thorough skin examination, often using a specialized magnifying tool called a dermatoscope. If the lesion is concerning, the doctor will recommend an excision biopsy. This involves surgically removing the entire growth and a small margin of surrounding healthy tissue. Complete removal is the preferred method for NM, allowing for accurate pathological assessment of the tumor’s depth, which is a significant factor in determining prognosis and treatment.