A 36 year-old presents for evaluation of a rapidly enlarging nodule on the shoulder.
Key point: Nodular melanoma may appear without an antecedent small or superficial precursor. These are aggressive lesions which carry a bad prognosis.
Treatment: The lesion was widely and deeply excised. Sentinel lymph node study revealed involvement of ipsilateral lymph nodes, and FDG-PET scan disclosed widespread osseous and hepatic metastases. The patient is currently receiving a recently approved drug for advanced melanoma (ipilimumab).
Note: New drugs for advances melanoma have offered some modicum of hope in erstwhile hopeless cases. However, we still have no “cure” for most advanced melanoma.