Introduction. Nodular melanoma is an aggressive subtype of cutaneous melanoma characterized by rapid vertical growth, increased Breslow thickness at diagnosis, and early metastatic potential. Its atypical clinical presentation may mimic other skin tumors, leading to delayed recognition. Case Report. A 78-yearold patient presented with a giant, ulcerated, whitish, cauliflower-like tumor on the back, measuring 16 × 11 × 5 cm and attached by a narrow stalk. The initial clinical impression favored cutaneous squamous cell carcinoma. Radical excision with a 2.5 cm safety margin was performed. Histopathological examination confirmed nodular melanoma with Breslow thickness > 10 mm, Clark level IV, ulceration, satellitosis, and perivascular and intravascular invasion. Sentinel lymph node biopsy was recommended but declined. The patient did not return for follow-up, and the clinical outcome remains unknown. Discussion. This case highlights several diagnostic challenges. Giant nodular melanomas (> 10 cm) are rare, and minimal pigmentation may contribute to misdiagnosis. The tumor exhibited multiple highrisk features associated with nodal and distant metastasis. Early biopsy and accurate differential diagnosis are essential, as exophytic or atypical lesions may resemble non-melanocytic tumors. Conclusion. Atypical presentations of nodular melanoma require heightened clinical vigilance. Early recognition, appropriate surgical management, and adherence to staging protocols are essential for optimal outcomes.
Vlačić et al. (Thu,) studied this question.
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