Skin cancer treatment in India
If you have darker skin you are at lower risk of skin cancer, and if you develop one it is more likely to be somewhere the sun never reaches: the sole of a foot, a palm, or under a nail. That mismatch between where people look and where it appears is why it is so often found late.
- Lower risk in darker skin
- But worse outcomes, because it is usually diagnosed later
- Where to look
- Soles, palms, under nails, inside the mouth. Not only sun-exposed skin
- Main types
- Basal cell, squamous cell, and melanoma, which is the dangerous one
- First test
- A biopsy. No scan and no photograph can replace it
- Treatment
- Surgery for most; immunotherapy has transformed advanced melanoma
- First step
- Send clear photographs and any biopsy report for review on video, free
The thing most skin cancer advice gets wrong for our patients
Nearly all public information about skin cancer is written for pale skin: stay out of the sun, watch moles on your back and shoulders, use sunscreen. Melanin does provide substantial protection, and skin cancer is genuinely less common in people with darker skin.
But outcomes are frequently worse, and the reason is where it appears and how late it is found. In darker skin, melanoma has a strong tendency to arise on the palms, the soles of the feet, under the fingernails or toenails, and on mucous membranes such as the inside of the mouth. These are not sun-exposed sites, they are not where anyone has been told to look, and a dark patch on the sole of a foot is easily mistaken for a bruise, a callus or a fungal problem for a year or more.
So the practical advice for our patients is different from the standard advice. Look at the soles of your feet and your palms. Look at your nails. A dark streak running the length of a nail, particularly one that is widening or where the pigment spreads onto the surrounding skin, needs a doctor. A sore on the foot that has not healed in weeks needs a doctor, not more dressings.
The three main types
- Basal cell carcinoma. The commonest skin cancer overall. Grows slowly, almost never spreads, but keeps enlarging locally and destroying tissue if ignored. Cured by complete removal.
- Squamous cell carcinoma. Can spread to lymph nodes, so it is treated more seriously than basal cell. Often arises in scars, chronic wounds and long-standing ulcers, which matters for anyone with a burn scar or a wound that has never properly healed.
- Melanoma. Much less common but far more dangerous, because it can spread early. This is the one where speed of diagnosis changes everything.
A biopsy is what distinguishes them. No photograph, no scan and no clinical impression is a substitute, and anyone offering to treat a suspicious lesion without one is doing it wrong.
What warrants getting checked
- A dark patch on the palm or sole, particularly if it is enlarging or changing shape
- A dark streak in a nail that is widening, or where pigment spreads onto the skin at the nail fold
- A mole that changes in size, shape or colour, or that itches, bleeds or crusts
- A sore that has not healed after several weeks
- A new growth in an old scar or a long-standing ulcer
- A dark spot inside the mouth or on the lip
Treatment
For most skin cancers, surgery is the treatment and it is usually curative. The lesion is excised with a margin of normal skin around it, the width of that margin depending on the type and thickness. Larger defects may need a skin graft or a flap to close, which is where reconstructive surgery comes in, particularly on the face.
For melanoma, one additional step matters: a sentinel lymph node biopsy. A tracer identifies the first lymph node the area drains to, that node is removed and examined, and the result tells you whether the melanoma has begun to spread. It changes both the outlook and the treatment that follows, and it needs to be done at the time of the main surgery rather than afterwards. If melanoma surgery has been proposed to you without any mention of it, ask.
Melanoma on the sole or under a nail sometimes requires more extensive surgery because of where it sits, and the reconstruction of a weight-bearing surface needs thought. This is worth having done by a team that treats melanoma regularly.
Advanced melanoma
This is one of the genuine transformations in cancer medicine over the past decade. Immunotherapy has changed the outlook for advanced melanoma more dramatically than for almost any other cancer, and targeted drugs work well in melanomas carrying particular mutations, most commonly BRAF.
Two things follow. First, advanced melanoma is no longer a situation where treatment is futile, and anyone telling you otherwise is working from outdated information. Second, your tumour should be tested for the relevant mutations, because that testing decides which drugs can be used. Ask whether it has been done.
These drugs are the most expensive part of any melanoma plan by a wide margin, and they are priced by drug and duration rather than as a package, so ask for them to be estimated separately and for an expected duration of treatment.
What we can say about the shape of the cost: surgical removal of a skin cancer is at the less expensive end of cancer treatment, while immunotherapy and targeted drugs for advanced melanoma are among the most expensive treatments in oncology. If drug therapy is being proposed, ask for the cost per cycle and the expected number of cycles before you commit to travelling.
Questions patients ask
Do people with dark skin get skin cancer?
Yes, though less often than people with pale skin. The important difference is where: in darker skin, melanoma tends to appear on the palms, the soles of the feet, under the nails and on mucous membranes rather than on sun-exposed areas. Because nobody thinks to look there, it is frequently found late, and outcomes suffer as a result.
I have a dark line under my nail. Should I worry?
It needs checking, particularly if it is widening, if it is only on one nail, or if the pigment is spreading onto the skin around the nail fold. Most such streaks are harmless, but subungual melanoma presents exactly this way and is regularly mistaken for a bruise or a fungal infection for a long time.
How is skin cancer diagnosed?
By biopsy. A sample of the lesion is examined under a microscope, and that is what distinguishes basal cell carcinoma, squamous cell carcinoma and melanoma from each other and from harmless lesions. No photograph, scan or clinical impression replaces it, and treatment should not begin without it.
How much does skin cancer treatment cost in India?
We publish no figure, because skin cancer surgery is not on the partner-hospital price list this site quotes from. What we can say is that surgical removal sits at the less expensive end of cancer treatment, while immunotherapy and targeted drugs for advanced melanoma are among the most expensive treatments in oncology. Ask for drug costs per cycle and an expected duration.
What is a sentinel node biopsy and do I need one?
For melanoma, a tracer identifies the first lymph node the area drains to; that node is removed and examined to see whether the melanoma has begun to spread. It changes both the outlook and the treatment that follows, and it has to be done at the time of the main surgery rather than later. If melanoma surgery has been proposed without mention of it, ask why.
Is advanced melanoma treatable?
Far more so than it was a decade ago. Immunotherapy has transformed the outlook for advanced melanoma more than for almost any other cancer, and targeted drugs work well in melanomas carrying particular mutations such as BRAF. Anyone telling you that advanced melanoma cannot be treated is working from outdated information. Ask whether your tumour has been tested for those mutations.
A sore on my foot has not healed for months. Does that matter?
It is worth having examined rather than dressed indefinitely. A wound that does not heal can be a squamous cell carcinoma, and in darker skin a pigmented lesion on the sole can be a melanoma mistaken for a callus or a bruise. Both are far easier to treat early.