What the diagnosis means
Basal cell and squamous cell carcinomas are the most common skin cancers, grow locally, and are almost always cured by removal. Melanoma arises from pigment cells, is less common but can spread; in Indian patients it more often occurs on the soles, palms or nails (acral melanoma) or in mucosal sites rather than on sun-exposed skin. The biopsy reports the thickness (Breslow depth), ulceration and other features that decide staging and the need for further tests.
Where medical oncology fits
- Surgery by a surgical oncologist, dermatologist or plastic surgeon removes the cancer with a margin; for melanoma above a certain thickness, a sentinel lymph-node biopsy assesses spread.
- High-risk melanoma after surgery (stage IIB–III): a year of immunotherapy or, for BRAF-mutant melanoma, targeted tablets, reduces the chance of relapse — a medical oncology decision.
- Advanced or metastatic melanoma: immunotherapy (single or combined checkpoint inhibitors) or BRAF/MEK-targeted tablets have replaced chemotherapy as first-line treatment.
- Advanced non-melanoma skin cancer not treatable by surgery or radiation: immunotherapy for squamous cell carcinoma; hedgehog-pathway inhibitors for basal cell carcinoma.
Radiation oncology treats some skin cancers directly and helps control disease in lymph nodes or bone.
Testing that matters
Melanoma should be tested for BRAF mutation (and sometimes NRAS, KIT — the latter more relevant in acral and mucosal melanoma). The result decides whether a targeted tablet is an option.
What to expect
Immunotherapy is given as infusions every 2–6 weeks; the main risks are immune-related effects on the skin, gut, glands, liver and lungs, watched for with regular blood tests. Targeted tablets are taken daily with fever, rash and tiredness as the common effects. Regular skin and lymph-node checks continue for years after treatment.
Questions to ask
- Is this a melanoma or a non-melanoma skin cancer, and what stage?
- Do I need a sentinel-node biopsy or further imaging?
- Has BRAF testing been done?
- After surgery, would immunotherapy or targeted therapy reduce my risk, and is it worth it in my case?
- How should I check my skin and protect it going forward?
Preparing for your consultation
Bring the biopsy/excision report (with Breslow depth for melanoma), any scan reports, photographs of the lesion if available, molecular test results, and a medicine list; note any history of organ transplant or immune suppression.