Melanoma in India: why the messaging needs to change to catch it early

A 3D structure of a melanoma cell derived by ion abrasion scanning electron microscopy Thousands of patients in India are diagnosed with melanoma, a type of skin cancer, each year. While melanoma is far less common here than in Western populations, it is far from rare and the way it presents in our patient population makes it uniquely difficult to detect early. Too many patients come to us when the disease is already advanced, precisely at a time when treatment options have never been more powerful or more personalised. This contrast between available therapies and the stage at which patients are diagnosed defines one of the most pressing challenges in melanoma care in India today.Why melanoma gets missedThe warning signs most people associate with skin cancer come from research developed for fairer-skinned populations, where melanoma tends to appear on sun-exposed areas as an irregular or darkening mole. That picture does not reflect what clinicians see in India.Melanoma here, most commonly presents on the soles of the feet or beneath the nails, sites that are rarely examined and even more rarely associated with cancer. This condition is called acral lentiginous melanoma, a subtype that accounts for 35 to 60% of cases in dark-skinned individuals. Such lesions are frequently mistaken for bruises, fungal infections, or diabetic ulcers, and by the time a biopsy is taken, the disease has often progressed.Mucosal melanomas, a rare type of cancer that starts in the mucous membranes, are highly aggressive with a very low chance of recovery and produce few early warning signs. Most are diagnosed only after spread has occurred.Any pigmented lesion that changes or persists, wherever it appears on the body, deserves investigation rather than reassurance.A decade of transformationWhen I began my oncology career, managing advanced melanoma meant offering patients limited and rarely durable options. That has fortunately changed significantly.The foundational shift came from James Allison and Tasuku Honjo, whose discoveries on CTLA-4 and PD-1 earned them the 2018 Nobel Prize in Physiology or Medicine. Their research established the principle of immune-checkpoint blockade: rather than attacking a tumour directly, we can sometimes release the biological brakes that stop the patient’s own immune system from doing so. The results can be extraordinary. Former U.S. President Jimmy Carter was diagnosed at 91 with melanoma that had spread to his liver and brain. Surgical resection of liver disease, stereotactic radiation for the brain, and immunotherapy with the checkpoint inhibitor pembrolizumab produced a durable remission, and he lived to 100.Precision medicine has reshaped the approach in parallel. Some melanomas carry specific mutations, particularly in the BRAF pathway, that can be directly targeted with molecularly designed therapies. This is where next-generation sequencing, or NGS, becomes critical. In simple terms, it reads the genetic blueprint of a patient’s tumour and identifies the alterations that should guide treatment, turning what was once a single clinical decision into a detailed, individualised process.The melanoma story is not over; it is only becoming more exciting. TIL therapy takes tumour-infiltrating lymphocytes, expands them in the laboratory, and reinfuses them in far greater numbers, a step toward truly personalised cellular treatment. In August 2026, intismeran, a personalised mRNA vaccine built from the patient’s own tumour sequence, was combined with pembrolizumab in high-risk melanoma patients after surgery. The results were striking: a significant reduction in recurrence compared with pembrolizumab alone, making it the first positive late-stage trial of a personalised mRNA cancer vaccine, though survival data remain pending. What still needs to changeAll of these advances deliver their best results when treatment begins early. The more sophisticated our therapies become, the more clearly we see that they work best before the disease has spread. In India, awareness and referral gaps continue to push diagnosis toward advanced stages.Recalibrating public health messaging to reflect how melanoma actually presents in Indian patients is a start. Faster pathways from primary care to specialist centres matter equally. More fundamentally, India needs a national melanoma registry, stronger epidemiological and genomic data, more clinical trials in Indian patients, and deeper international collaboration. The advances of the past decade are genuinely extraordinary. Whether they reach the patients who need them comes down to one thing: a diagnosis early enough to act on.(Prof. Jyoti Bajpai is director – medical precision immuno-oncology, Apollo Hospitals, Mumbai & Western Zone. drjyoti_ba@apollohospitals.com) Published - September 12, 2026 02:15 pm IST