Changes in the presentation of nodular and superficial spreading melanomas over 35 years

Abstract

BACKGROUND Nodular melanoma (NM) may be biologically aggressive compared with the more common superficial spreading melanoma (SSM), with recent data suggesting underlying genetic differences between these 2 subtypes. To better define the clinical behavior of NMs, the authors compared their clinical and histopathologic features to those of SSMs at their institution, a tertiary referral center, over 3 decades. METHODS A total of 1684 patients diagnosed with 1734 melanomas were prospectively enrolled. Of these, 1143 patients (69% SSM, 11% NM, 20% other) were diagnosed between 1972 and 1982; 541 patients (54% SSM, 23% NM, 23% other) were diagnosed between 2002 and the present. Differences between the features of NM and SSM within each time period as well as changes over time were analyzed. RESULTS The authors found that SSMs are now diagnosed as thinner lesions (P < .0001) with a low incidence of histologic ulceration (P < .0001), whereas there was no significant change in the median tumor thickness or ulceration status of NMs over time (P = .10, P = .30, respectively). The median age at diagnosis of NM, however, did significantly increase over time (51 years to 63 years, P < .01). The median duration of NMs was reported to be only 5 months compared with 9 months in SSM patients. CONCLUSIONS The authors’ data suggest that improvements have been made in the early detection of SSM but not NM. Modifications of current screening practices, including increased surveillance of high-risk patients with an emphasis on the “E” for “evolution” criterion of the ABCDE acronym used for early detection of melanoma, are thus warranted.

Telomerase reverse transcriptase promoter mutations in primary cutaneous melanoma

“…Another distinct feature of NM is the lack of radial growth phase and exclusive progression in vertical manner, which was found to be associated with the presence of the TERT promoter mutations. However, NMs tend to be diagnosed at later stages bearing an increased Breslow thickness, which was reflected in a multivariate model 38 .…”

Impact of Socioeconomic Status and Ethnicity on Melanoma Presentation and Recurrence in Caucasian Patients

“…Given that tumor depth is one of the most important predictors of melanoma survival, and nodular melanomas make up the majority of thick melanomas, a disproportionate distribution of nodular melanoma may negatively impact survival in lower-income groups [36]. Differences in sun exposure patterns may contribute to the observed increased risk of nodular melanoma in the lower MHI population, as a pattern of chronic sun exposure has been associated with both nodular melanoma and lower SES groups [11,37]. Further studies are needed to independently validate and explain the potential correlation between nodular melanoma and lower income.…”

Late diagnosis of nodular melanoma of the foot in a 74-year-old Brazilian man

“…The new acronym CUBED (Colored lesion, Uncertain diagnosis, Bleeding lesion, Enlargement of the lesion, Delay in healing of the lesion beyond 2 months) has been useful to obtain an earlier recognition of foot and nail MM 2,3 . Nodular melanoma is prevalent in older male patients, and appears with smaller diameter, more regular border and uniform color than superfi cial spreading melanoma; and ulceration is considered an indicative sign of tumor aggressiveness and poor prognosis 8 . MM often affects individuals with antecedent moles, dysplastic or congenital nevi, and lentigo maligna, and predisposing factors may be genetic, biological, ultraviolet radiation, and trauma.…”