What is the cause of nodular melanoma?
Nodular melanoma is due to the development of malignant pigment cells (melanocytes) along with the basal layer of the epidermis. These cells may occasionally arise from an existing melanocytic naevus (about 3%) but commonly occur within another type of melanoma or in previously normal-appearing skin. What triggers the melanocytes to become malignant is unknown, but it is likely to be a series of changes to the DNA. NRAS mutations are often found in patients with nodular melanomas.What is the treatment for nodular melanoma?
The initial treatment of primary melanoma is to cut it out; the lesion should be completely excised with a 2-3 cm margin of normal tissue. Further treatment depends mainly on the Breslow thickness of the lesion.What happens at follow-up of melanoma?
The primary purpose of follow-up is to detect recurrences early, but it also offers an opportunity to diagnose a new primary melanoma at the first possible opportunity. A second invasive melanoma occurs in 5-10% patients; an unrelated melanoma in situ affects in more than 20% of melanoma patients.
- Self-skin examination
- Routine skin checks by a patient's preferred health professional
- Follow-up intervals are preferably six-monthly for five years for patients with stage 1 disease, three-monthly or four-monthly for five years for patients with stage 2 or 3 disease, and yearly after that for all patients.
- Individual patient’s needs should be considered before an appropriate follow-up is offered
- Provide education and support to help the patient adjust to their illness
The follow-up appointments may be undertaken by the patient's general practitioner or specialist, or they may be shared.
Follow-up appointments may include:
- A check of the scar where the primary melanoma was removed
- A feel for the regional lymph nodes
- A general skin examination
- A full physical examination
- In those with many moles or atypical moles, baseline whole-body imaging and sequential macro and dermoscopic images of melanocytic lesions of concern (mole mapping).
In those with more advanced primary disease, follow-up may include:
- Blood tests, including LDH
- Imaging: ultrasound, X-ray, CT, MRI and PET scan.
Tests are not typically worthwhile for stage 1/2 melanoma patients unless there are signs or symptoms of disease recurrence or metastasis. And no tests are thought necessary for healthy patients who have remained well for five years or longer after removal of their melanoma, whatever stage.