Delay can be deadly…

New nodular lesions need to be regarded with a high level of suspicion

Nodular melanomas comprise less than 10% of melanomas, but are disproportionately responsible for melanoma deaths.

Clinically they are often nearly symmetrical and lacking the usual ‘ABCD’ criteria. At dermatoscopy they commonly lack standard criteria for melanocytic lesions such as reticular lines (network).

As well as being difficult to diagnose, they also grow rapidly, with a median increase in Breslow thickness of 0.49mm per month. 

A high level of suspicion is required when assessing new nodular lesions, to reduce deaths from nodular melanoma.