Skin cancer treatment depends on the type of cancer, how deeply it has grown, where it is located, and whether it has spread. Most localised basal cell and cutaneous squamous cell carcinomas can be treated with surgery. Melanoma also usually starts with surgery when it is confined to the skin, but the biopsy may show a need for lymph node staging or additional treatment. For selected advanced skin cancers, immunotherapy or targeted medicines can be part of the plan. [1–3]
By Dr Raman Narang, Consultant Medical & Hemato-Oncologist, New Delhi
A sore on the nose that repeatedly crusts and a new dark streak under a toenail may both need a skin examination. If a biopsy confirms cancer, the next steps can be quite different. If you are seeking skin cancer treatment in Delhi, ask for the exact diagnosis and which findings determine the next step. The location matters for planning surgery, while the pathology helps determine whether lymph node assessment, scans, or further treatment would add value.
1. What are the signs and risk factors for skin cancer?
A sore that does not heal, a spot that repeatedly bleeds or crusts, a firm growing lump, or a mole that changesdeserves assessment. Skin cancer can develop in people with any skin tone. In Indian patients, it is worth paying attention to changes on the palms, soles, and around or under the nails, as well as sun-exposed skin. [1, 4]
| What you might notice | Why it deserves assessment |
|---|---|
| A shiny or pearly bump, a sore that repeatedly crusts, or a flat scar-like patch | These can be signs of basal cell carcinoma. Some lesions are brown or black. |
| A rough, scaly patch, firm growing bump, or persistent ulcer | These can be signs of cutaneous squamous cell carcinoma. A changing ulcer in a long-standing scar also deserves review. |
| A mole or spot that changes shape, colour, or size | Change over time is an important clue to melanoma. Some melanomas appear pink or red. |
| A new or widening dark streak under one nail, or a changing patch on the sole or palm | These changes can have several causes, including acral melanoma. Assessment is especially important if pigment spreads onto nearby skin. |
The ABCDE guide can help identify a suspicious mole: Asymmetry, irregular Border, uneven Colour, Diameter, and Evolution, meaning change over time. A melanoma can be smaller than 6 mm, so a changing spot deserves review regardless of size. [4]
Ultraviolet exposure from sunlight is an important risk factor for several skin cancers. Other factors include a personal history of skin cancer, a family history of melanoma, and immune suppression, particularly after an organ transplant. Acral melanoma can arise on skin that gets little sun exposure. [1, 3, 4]
2. How are skin cancers classified and diagnosed?
A clinician examines the lesion and may use dermoscopy, a handheld magnifying instrument that shows features beneath the skin surface. A biopsy establishes the diagnosis. When melanoma is suspected, the preferred approach is usually to remove the entire visible lesion at full thickness with a narrow margin, where feasible. For a large lesion or one in a difficult location, such as under a nail, the specialist may plan a targeted biopsy. [1, 3]
| Main type | What the biopsy can tell the team |
|---|---|
| Basal cell carcinoma (BCC) | BCC generally grows locally and rarely spreads to distant organs. The microscopic growth pattern, location, and whether it has returned after treatment help determine how to remove it. |
| Cutaneous squamous cell carcinoma (cSCC) | This cancer starts in squamous cells of the skin. Most cases are localised. Deeper invasion, growth along a nerve, or other high-risk features can increase the chance of recurrence or lymph node spread. |
| Cutaneous melanoma | Melanoma starts in pigment-producing cells. The report describes Breslow thickness, which measures the depth of the melanoma in millimetres, and ulceration, which means the skin surface over the tumour has broken down microscopically. These findings help guide surgery and lymph node staging. |
Melanoma in situ is confined to the outermost layer of the skin. Invasive melanoma has grown deeper. For selected invasive melanomas, a sentinel lymph node biopsy checks the first draining lymph node for microscopic spread. It is generally discussed for tumours over 1 mm thick and may also be considered for thinner tumours with particular risk features. Scans are used selectively when the stage, symptoms, or examination suggest they could change the plan. [3]
3. How are basal cell and cutaneous squamous cell carcinomas treated?
For many localised basal cell carcinomas and cutaneous squamous cell carcinomas, the main treatment is surgical excision. The doctor removes the tumour with a margin of surrounding skin, and the tissue is checked for cancer at the edges. The recommended margin and the method of repair depend on the type, site, and risk features. [1]
Mohs micrographic surgery removes the cancer in thin layers and checks the edges during the procedure. It can be helpful for selected tumours in areas where preserving healthy skin matters, such as around the eyelid, nose, lip, or ear. It may also be considered for certain recurrent tumours or those with higher-risk features. [1]
- Basal cell carcinoma. Selected superficial, low-risk lesions may be suitable for a topical or another local treatment. Radiation may be an option when surgery is unsuitable. For uncommon advanced cases, a Hedgehog pathway inhibitor such as vismodegib may be considered. Immunotherapy can be an option for some patients after specialist review. [1]
- Cutaneous squamous cell carcinoma. If the pathology shows higher-risk features, the team may assess nearby lymph nodes and discuss radiation after surgery. For unresectable or metastatic disease, PD-1 immunotherapy, such as cemiplimab, may be appropriate. The US FDA also approved postoperative cemiplimab for eligible adults at high risk of recurrence after surgery and radiation. For care in Delhi, the team should verify the applicable Indian prescribing indication and access. [1, 2]
4. How is melanoma treated at different stages?
Wide local excision is the main treatment for melanoma confined to the skin. This usually means removing additional skin around the biopsy site. The margin depends on the thickness and location of the melanoma. If sentinel lymph node biopsy is appropriate, it is usually planned with the definitive operation. [3]
| Clinical situation | What the team usually discusses |
|---|---|
| Melanoma in situ or thin, low-risk invasive melanoma | Definitive excision and a skin follow-up plan. |
| Stage IIB or IIC melanoma after complete removal | Whether postoperative anti-PD-1 immunotherapy could reduce the risk of recurrence enough to justify the potential side effects. |
| Stage III melanoma | Whether surgery, immunotherapy, or both are appropriate. For selected patients with clinically detectable, removable nodal disease, immunotherapy before surgery may be discussed. After surgery, eligible patients with a BRAF V600 mutation may also have a targeted treatment option. |
| Unresectable or metastatic melanoma | Systemic treatment with immunotherapy or, for eligible BRAF V600–mutated melanoma, a combination of BRAF and MEK inhibitors. Radiation or surgery may help control specific sites or relieve symptoms. |
For advanced melanoma, the first choice also depends on where the disease has spread, how quickly it is progressing, and whether the patient has conditions that affect immunotherapy safety. If both immunotherapy and targeted therapy are reasonable, ask why the team recommends one first and what would change that choice. [3]
What I look for clinically before recommending treatment
I first check whether the biopsy establishes the exact type and provides enough information to plan the next procedure. For melanoma, I look at Breslow thickness, ulceration, and the biopsy margins before discussing wider excision or sentinel lymph node biopsy. For squamous cell carcinoma, I check for features that could make lymph node assessment or postoperative radiation relevant. I also ask about organ transplantation and medicines that suppress the immune system, because these can affect the safety of immunotherapy.
How the next step is decided
| If the reports show… | The next discussion is about… |
|---|---|
| A changing mole, nail streak, or non-healing sore without a diagnosis | Skin examination and the best way to obtain a biopsy |
| A localised basal cell carcinoma in a sensitive area | Standard excision or Mohs surgery, and how the area would be repaired |
| A squamous cell carcinoma with high-risk features | Whether lymph node assessment, imaging, or radiation would add value |
| Invasive melanoma | Wider excision and whether sentinel lymph node biopsy is appropriate |
| Unresectable or metastatic melanoma | Immunotherapy, BRAF testing, and any urgent need to treat a specific site |
What to bring to a skin cancer consultation in Delhi
- Biopsy and surgical pathology reports, with details for obtaining the slides or tissue block.
- A dated photo of the lesion before biopsy, if available, especially if the exact site is now difficult to identify.
- Previous operation notes, including any skin graft or reconstructive procedure.
- Lymph node biopsy results, scan reports, and original images, if available.
- BRAF or other molecular test reports, if already performed.
- A list of medicines and any history of organ transplant, autoimmune disease, or previous skin cancer.
Frequently asked questions
Can people with darker skin develop skin cancer?
Yes. Skin cancer can occur in any skin tone. A changing patch on the palm or sole, a new or widening nail streak, or a sore that persists should be assessed. [4]
Does every skin cancer need Mohs surgery?
Standard excision is suitable for many localised skin cancers. Mohs may be helpful when the location, risk of recurrence, or need to preserve surrounding skin makes checking the margins during surgery particularly valuable. [1]
Why might I need another operation if the melanoma was removed during biopsy?
The biopsy establishes the diagnosis and measures the melanoma’s depth. A wider excision usually follows to remove a recommended margin around the biopsy site. [3]
Does everyone with melanoma need lymph node surgery or immunotherapy?
The need for sentinel lymph node staging depends on thickness and other risk features. Immunotherapy is considered in specific higher-risk, unresectable, or metastatic settings. Many early melanomas are treated with excision and follow-up. [3]
Before treatment, ask your team to write down the exact skin cancer type, the features that affect the risk of recurrence or spread, and the purpose of the next step. If more than one procedure is possible, ask how each would affect cancer control, reconstruction, and follow-up.
This page is for general education. Individual treatment decisions require review of your examination findings, pathology, and overall health by your treating team.
Clinical references
- National Cancer Institute. Skin Cancer Treatment (PDQ) and Skin Cancer Prevention (PDQ). Sections on basal cell and cutaneous squamous cell carcinoma.
- US Food and Drug Administration. FDA Approves Cemiplimab-rwlc for Adjuvant Treatment of Cutaneous Squamous Cell Carcinoma. October 2025.
- European Society for Medical Oncology. Cutaneous Melanoma: ESMO Clinical Practice Guideline for Diagnosis, Treatment and Follow-up. 2025.
- American Academy of Dermatology. Finding Skin Cancer in Darker Skin Tones and Melanoma: Signs and Symptoms.
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