More awareness needed of melanomas that look like pimples

An Australian melanoma expert says New Zealanders and their doctors need to be more aware that some of the most aggressive and deadly melanomas look like persistent pimples or blood blisters.

In Victoria, over a 20-year period, these aggressive melanomas accounted for nearly half of all skin cancer-related deaths, but only 13.5 percent of melanomas.

Professor John Kelly, from the Victorian Melanoma Service at Alfred Hospital, has told the fifth national Melanoma Summit in Auckland that nodular melanomas are often overlooked because they don’t look like what we’ve been taught to look for when checking our skin.

He says both patients and doctors are quite good at finding the more typical flat, unevenly coloured melanomas with irregular and changing shape and colour.

“But nodular melanomas look quite different. They are small, red, firm to the touch and regular in shape, usually on the head and neck. To begin with, they’re not obviously a cancer. But they’re growing in depth from the get go, whereas ordinary inflammatory nodules will come and go in a month.

“They usually stand out, even in sun damaged skin. They ulcerate early and bleed, which can be a helpful tipoff to pay attention to them.

“They’re easily overlooked and people who have them may be told they’re nothing to worry about. But they grow quickly in depth – four times the rate of other melanomas – so any delay beyond the first month or two is critical.

“If they can be removed in the first couple of months, the great majority of them would be cured and the death rate from nodular melanoma would come down dramatically.”

Professor Kelly says although awareness campaigns and screening efforts have improved early detection of common melanomas over the last 15 years, there has been no improvement in the detection of nodular melanoma.

“Of all the skin cancers that contribute to deaths, this is the most important and has received the least attention. The general public and health care practitioners need to be on the lookout for these melanomas so that they are treated with the urgency they deserve.”

A recent New Zealand study interviewed 249 people who had a recent diagnosis of nodular melanoma.

Twenty-five percent reported it took six months or more for their nodular melanoma to be diagnosed from the time they first thought something was wrong with their lesion. Twenty-four percent were diagnosed in between two to five months and 41 percent were diagnosed in a month or less.

Sixty-one of those surveyed reported their lesion was red in colour. Other presenting symptoms of nodular melanoma included bleeding or crusting, itching, pain or inflammation.

The National Melanoma Summit is hosted by Melanoma Network of New Zealand with support from the Health Promotion Agency.

The two-day Summit programme features overseas and New Zealand experts recognised internationally for their contribution to melanoma control. It also includes workshops that will enable participants to learn from each other and collaborate on initiatives focusing on melanoma prevention, diagnosis, clinical management and research.

Professor John Kelly, AM

Professor John Kelly trained as a dermatologist in Melbourne and undertook his doctorate at the Melanoma Clinic, University of California San Francisco, on the subject of melanoma diagnosis and management.

In 1994 he founded Victoria’s largest multidisciplinary treatment service for melanoma, the Victorian Melanoma Service at the Alfred Hospital.

Professor Kelly lectures widely on melanoma and has served on the board of the Australia and New Zealand Melanoma Trials Group. He is a member of the Executive Committee for the Clinical Practice Guidelines for the Management of Melanoma in Australia and New Zealand.

He was awarded a Member of the Order of Australia in 2018 for “significant service to medicine through the management and treatment of melanoma, as a clinician and administrator and to education".