Nodular melanoma.

Area of Science:

• Dermatology
• Oncology
• Pathology

Background:

• Nodular melanoma (NM) is the second most common cutaneous melanoma subtype.
• NM accounts for a significant proportion of melanoma-related deaths.
• Diagnostic challenges persist due to NM's rapid growth and varied clinical presentation.

Purpose of the Study:

• To summarize the epidemiology, risk factors, clinical presentation, histopathology, molecular characteristics, and treatment of NM.
• To highlight current diagnostic and management challenges associated with NM.
• To inform clinical practice and future research directions for nodular melanoma.

Main Methods:

• Comprehensive review of existing literature including reviews, cross-sectional studies, guidelines, and clinical reports.
• Synthesis of epidemiological data, clinical findings, and histopathological features.
• Evaluation of molecular attributes and current treatment strategies.

Main Results:

• Incidence and diagnostic severity of NM have not changed significantly over recent decades.
• Dermatoscopy and histopathology are crucial for NM diagnosis, potentially augmented by reflectance confocal microscopy.
• NM often presents at a thicker, higher stage, impacting treatment decisions.

Conclusions:

• Despite its prevalence and severity, NM presents ongoing diagnostic difficulties.
• Management guidelines vary, and the advanced stage at diagnosis necessitates tailored biopsy techniques, consideration of gene expression profiling, and prompt multidisciplinary oncology collaboration.
• Early initiation of systemic immunotherapies is crucial for managing advanced NM.