In such cases, one questions himself about his ability of early recognition of melanoma, which is of great importance in the right on time removing of the nevus (or melanoma).
In your opinion, is it more a question of ignorance (you do not see, because you do not know) or could it be attributable to the nature of the tumor that can appear so suddenly and abruptly?
I think it is due the nature of melanoma that can appear so suddenly and abruptly.
So we may emphasize to the importance of the clinical follow up of the patients with melanoma for the possibility of the recurrence, or of the patients with atypical nevi syndrome
Also it is important to educate our patients to refer immediately to their doctors any changes in their nevi
Sir,
True nodular melanomas NEVER arise in a nevus. They always arise de novo, which means they are nodular from the very beginning. This is the definition of nodular melanoma. However, vertical growth phase in already present superfitial spreading melanoma (SSM) is usually mistaken for nodular melanoma. Vertical growth phase looks like a nodule, but it is NOT a nodular melanoma since it has its horizontal phase of SSM.
Chances to miss melanoma and to allow to develop into vertical growth phase are zero if regularly followed-up with dermatoscopy.
Of course,
Milady,
Thank you for your resolute and unequivocal answer. But is it really so tidy? What about melanomas arising in atypic (dysplastic) nevi with only vertical growth phase? Aren't they also nodular melanomas, although by definition they have not the right to be? Is it really so easy to recognize a devoloping melanoma within them?
I think it depends on two things: the frequency of full skin checks (4x/year vs 1x/year) and the use of dermoscopy. In my experience, using the dermatoscope and learning the features of atypical moles with this method has increased my ability to identify and remove moles that are "changing". I did not learn how to use this in residency but now consider dermoscopy essential to detecting early melanoma.
Sir,
dysplastic naevi and common naevi could be the precursors of melanoma, of course. Again, vertical growth phase clinically present as nodus (therefore mistakenly called nodular) are possible to find in neglected lesions not followed up dermatoscopically. If followed only clinically. If dermatoscope is used, melanoma in a naevus would be excised before its horisontal growth phase. Yes, it is easy to recognise melanoma developing in a naevus if dermatoscope is used and lesions followed-up. I am performing dermatoscopy ffor many years.
The queston is: did you use dermatoscope or not? If yes, did you capture digital images? If not, this might be the explanation why "nodus" appeared "suddenly".
However, if your pathologist claims it is TRUE NODULAR melanoma with all histological characteristics, you should publish the case.
Thanks all for your precious answers, advices and suggestions. I perform dermoscopy in my everyday practice since 2001.
Cutaneous Melanomas Associated With Nevi
Caroline Bevona, MD; William Goggins, ScD; Timothy Quinn, MD; Julie Fullerton, BA; Hensin Tsao, MD, PhD. Arch Dermatol. 2003;139(12):1620-1624. doi:10.1001/archderm.139.12.1620.
Figure 3.Percentage of melanomas associated with nevi by histologic subtype.
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