Most people in Varanasi have never heard the word “melanoma.” Ask around, and you’ll find plenty of awareness about breast lumps or a persistent cough, but a dark, oddly-shaped mole rarely rings alarm bells here. That’s a problem, because melanoma is one of the few cancers that gives you a visible warning sign — often for months — before it becomes dangerous. The tragedy isn’t that it’s undetectable. It’s that it’s frequently ignored, mistaken for a harmless “kaala til” (dark mole), or treated at a local skin clinic with creams instead of being biopsied.

As a cancer surgeon practicing in Varanasi, I see this pattern more often than I’d like: a patient walks in with a mole that’s been “there for years” but has recently darkened, grown, or started bleeding — and by the time it’s evaluated properly, the disease has already advanced. This blog is an attempt to change that, one reader at a time.

What Exactly Is Melanoma?

Your skin has cells called melanocytes, which produce the pigment (melanin) responsible for your skin tone and for moles. Melanoma is what happens when these cells turn cancerous. It’s far less common than the other two types of skin cancer — basal cell and squamous cell carcinoma — but it’s also far more likely to spread to lymph nodes, lungs, liver, or even the brain if it isn’t caught early. That combination — rare but aggressive — is exactly why it deserves more attention than it currently gets.

Is Melanoma Actually a Concern in a City Like Varanasi?

There’s a common myth that melanoma is a “foreign” cancer, something that affects fair-skinned people in Europe or Australia who spend too much time in the sun. It’s true that sun-exposed, fair skin carries higher risk — but Indian patients, including those from Varanasi and the wider Purvanchal region, are far from immune. In fact, the pattern of melanoma we see in Indian patients is often different from what’s described in Western textbooks.

A large proportion of melanomas diagnosed in India show up in places that rarely see direct sunlight — the soles of the feet, the palms, under or around the nails. This subtype, called acral lentiginous melanoma, is often missed for months because neither patients nor primary care doctors think to look there. A dark streak under a toenail is dismissed as an old injury. A dark patch on the sole is blamed on walking barefoot. By the time it’s recognised for what it is, the tumour has often grown deeper into the skin.

Signs You Should Never Brush Aside

You don’t need to memorise medical terminology to protect yourself. The dermatology world uses a simple checklist called the ABCDE rule, and it works just as well for a patient in Varanasi as it does anywhere else:

• Asymmetry — one half of the mole looks nothing like the other half
• Border — the edges are ragged, blurred, or notched instead of smooth
• Colour — more than one shade is present: black, brown, tan, sometimes even red, white, or blue
• Diameter — larger than about 6mm, roughly the width of a pencil eraser
• Evolving — any change at all in size, shape, colour, height, or sensation over recent weeks or months

If a mole, spot, or nail discolouration ticks even one or two of these boxes, that’s reason enough to get it examined — not researched on the internet, not watched for “a few more months,” but physically examined by a surgeon or dermatologist who deals with skin cancer.

How We Confirm the Diagnosis

A suspicious lesion is first examined closely, often with a handheld magnifying tool called a dermatoscope. If anything looks concerning, the next step is a biopsy — removing the lesion or a sample of it to be studied under a microscope. This tells us not just whether it’s melanoma, but how deep it has grown (the Breslow thickness), which is the single most important factor in deciding treatment and predicting outcome. Depending on what the biopsy shows, we may also recommend imaging or a sentinel lymph node biopsy to check whether the cancer has reached the nearby lymph nodes.

Treatment: Why the Surgeon’s Skill Matters as Much as the Diagnosis

For melanoma, surgery isn’t just one option among several — it’s usually the foundation of the entire treatment plan. The tumour is removed along with a margin of healthy-looking skin around it, calculated precisely based on how deep the melanoma has grown. Too narrow a margin risks leaving cancer cells behind; too wide, and the patient is left with unnecessary tissue loss and a harder recovery. Getting this balance right takes experience, not guesswork.

If the lymph nodes are involved or at risk, a sentinel lymph node biopsy or a more extensive lymph node dissection may be required, and this is genuinely technical work — the kind of procedure where training and repetition matter.

This is where I try to bring my background to bear on every case. My training took me from AIIMS Delhi, where I completed my MS in General Surgery, to Tata Memorial Centre in Mumbai for my MCh in Surgical Oncology — India’s most intensive environment for learning cancer surgery. Later, I trained further in advanced and minimally invasive techniques in Lyon, France, and in complex laparoscopic and robotic surgery at Korea University in Seoul. I came back to Varanasi specifically to make this level of cancer care available here, without patients having to travel to Delhi or Mumbai for it. I also helped set up the minimally invasive cancer surgery department at Tata Memorial Centre, Varanasi, before moving into private practice to widen access even further.

For melanoma that has spread beyond the skin, surgery is combined with immunotherapy or targeted drug therapy under medical oncology, so the patient gets a complete, coordinated treatment plan rather than fragmented care.

Protecting Yourself: Practical Steps for Varanasi’s Climate

Varanasi’s sun is intense for most of the year, and outdoor work, travel, and religious activities near the ghats mean long hours of sun exposure for many residents. A few habits go a long way:

• Apply a broad-spectrum sunscreen (SPF 30 or higher) daily, not just in summer
• Avoid direct sun between 11 am and 4 pm when possible, especially near open water where reflection increases exposure
• Cover up with long sleeves, a hat, and sunglasses during prolonged outdoor activity
• Check your own skin every few months — don’t forget your palms, soles, scalp, and nails
• Don’t wait out a mole that’s changed. Get it looked at.

When Should You Actually See a Cancer Surgeon?

If a mole is new, growing, itching, bleeding, or simply doesn’t look like it belongs on your skin, that’s your cue. Waiting rarely helps with melanoma — the earlier it’s caught, the simpler the surgery and the better the outcome. As a surgical oncologist in Varanasi, I evaluate and treat melanoma and other skin cancers with the same surgical standards I trained in at AIIMS Delhi and Tata Memorial Centre, so patients from Varanasi and the surrounding Purvanchal region don’t have to travel elsewhere for expert care.

Frequently Asked Questions

Is melanoma common in Varanasi or eastern Uttar Pradesh?

It’s less common than in fair-skinned populations abroad, but it’s not rare, and cases are being picked up more often now that awareness and screening have improved. Because it’s often missed early here, patients tend to present at a later stage than they should.

Can a dark patch under my nail be melanoma?

It can be. A dark streak or patch under a nail that wasn’t caused by an injury, or one that doesn’t grow out with the nail, needs to be examined promptly rather than assumed to be a bruise or fungal stain.

Is melanoma surgery painful or disfiguring?

Modern surgical planning aims to remove the cancer completely while preserving as much healthy tissue and normal appearance as possible. The extent of surgery depends entirely on how advanced the melanoma is at diagnosis — which is one more reason early evaluation matters.

Where can I get melanoma diagnosed and treated in Varanasi?

Dr. Swapnil Patel provides melanoma evaluation, biopsy, and surgical treatment in Varanasi, backed by training from AIIMS Delhi, Tata Memorial Centre Mumbai, and international fellowships in advanced cancer surgery.

If you’ve noticed a mole or skin spot that concerns you, don’t wait for it to become an emergency. Book a consultation with Dr. Swapnil Patel, Cancer Surgeon in Varanasi, for a proper evaluation.