Discussion
Published reports of nodular melanomas in patients of African descent are rare. In the United States from 2004 to 2019, two case reports of NM in AA have been published. 5,6 The SEER database across 23 years records 87 cases of NM in AA, compared to 15,805 cases in Caucasians. 1 Of the Asian races, melanoma incidence is approximately twice as high in Japanese.2,4
Darker skin filters twice as much ultraviolet (UV) radiation as lighter skin.2,7 In evaluating the relationship between melanin and UV damage, Tadokoro et al, demonstrated that subjects with darker skin repaired UV damage at a higher rate than lighter skin.8 Despite inherent photoprotection and higher rate of repair, individuals with SOC exhibited significant UV damage, highlighting that even with low UV exposure there is DNA damage to all skin types.
V600E BRAF mutations have been identified in 66% of melanomas and associated with increased thickness, tumor ulceration, and truncal anatomic site. 9,10 NM is thought to arise from chronic sun-exposure, with similar risk factors as SSM: fair skin, freckling, and sunburns. 11 However, these risk factors are not predictive of the risk of melanomas in AA. Our patient received significant sun exposure during his time in service. His lesion is consistent with intermittent sun-exposure and an anatomical site, the abdomen, in which a BRAF mutation may occur.