Despair mixed with anger in Kocani, North Macedonia on Tuesday in the wake of a horrific nightclub fire that left dozens dead and even more injured, prompting demands for justice.

In the town of just 30,000 people, the deaths of 59 people – most of them teenagers and young adults – touched almost every home, with the agony of losing so many young people cutting especially deep.

"We are a small place. We all know each other," Sasko Jordanov, a 38-year-old dentist in Kocani, said.

"I am a doctor and have many patients dead, children of friends and neighbours."

"I have children – their friends died. This is horrible," said a woman as she lit candles at a makeshift shrine, where others left flowers and messages of condolence.

The fire rapidly spread as a crowd of young fans packed into Club Pulse to attend the performance by a popular hip-hop band, DNK.

The blaze was apparently started by fireworks onstage igniting the ceiling of the nightclub.

More than 500 people were crammed inside despite just 250 tickets being sold, according to officials.

Many of those killed were trampled as they rushed to the exits, while the roof was consumed with flames.

The prosecutor's office said the club had breached numerous fire regulations, including having insufficient extinguishers and emergency exits.

Interior Minister Pance Toskovski said investigators had determined the club owner operated under a forged licence, and vowed to crackdown on corruption. (AFP)