Melanoma

Melanoma is the most serious form of skin cancer — it starts in melanocytes, the cells that give skin its pigment. It is less common in Indians than in fair-skinned populations but more often aggressive because it is more likely to be in places overlooked (palms, soles, under nails), and because diagnosis is often delayed.

Signs to watch for — the ABCDE rule

• Asymmetry — one half looks different from the other.
• Border — irregular, notched, or blurred.
• Colour — variegated: brown, black, with patches of pink/red/white/blue.
• Diameter — often > 6 mm, but smaller melanomas exist.
• Evolving — changing in size, shape, or colour; new symptoms (itch, bleeding).
• Any new, growing, bleeding, or unusual mole deserves a dermatology opinion.

India-specific — acral and mucosal melanoma

Acral melanoma (palms, soles, under nails) and mucosal melanoma (mouth, anogenital) make up a larger share of Indian melanomas than the sun-related melanomas that dominate Western data. A new dark patch or a dark streak in a nail — particularly one that widens or doesn't grow out — needs review. Sun exposure is not necessary for these types; don't rule out melanoma because someone "isn't out in the sun much."

Diagnosis and staging

• Dermoscopy + biopsy (excisional, where possible).
• Staging by depth (Breslow thickness), ulceration, mitoses.
• Sentinel lymph node biopsy for selected cases.
• Scans (CT, MRI, PET) for advanced disease.
• Molecular testing (BRAF, NRAS, KIT) — guides targeted therapy.

Treatment

• Surgery — wide local excision; curative for early disease.
• Sentinel node biopsy and, when needed, lymph node dissection.
• Adjuvant immunotherapy or targeted therapy — for higher-risk stages; transformative for outcomes.
• Advanced / metastatic — checkpoint immunotherapy (PD-1, CTLA-4), BRAF-targeted therapy — the most impressive advances in recent oncology.
• Radiation — selected roles.

Prevention and awareness

• Daily broad-spectrum sunscreen on exposed skin; hats, sleeves.
• Monthly self-skin check; annual skin exam if risk factors.
• Don't use indoor tanning.
• Look under nails and at soles and palms — these get missed; show a Health Expert any new dark patch there.