Skin changes are often gradual and easy to miss. A mole may become slightly darker than it was a few months ago, develop an uneven surface, or feel different compared to other moles on the body. In the absence of pain or obvious discomfort, such changes are frequently dismissed. Doctors say that these subtle shifts can, in some cases, indicate early stages of malignant melanoma, one of the most aggressive forms of skin cancer.

Common moles (melanocytic nevi) are widespread, noncancerous skin growths resulting from clusters of melanocytes, with most adults having between 10 and 40, according to the United States’ National Cancer Institute. While these are usually benign, they are clinically significant as markers of skin cancer risk. An increased number of moles has been associated with a higher likelihood of melanoma, and their rising prevalence has paralleled the global increase in melanoma incidence.

Subtle signs in darker skin

Early warning signs in Indian skin often do not follow typical textbook patterns. According to Katheeja Nasika, consultant, department of dermatology, Rela Hospital, Chennai, ”Warning signs on Indian skin are frequently subtle. Individuals may experience a slight darkening, an uneven surface, or a small increase in height from the surface in their moles.” She adds that symptoms such as “painful or itchy sensations or bleeding after being rubbed against a piece of clothing” may occur, but are often overlooked.

At the same time, misconceptions about risks persist. M. A. Raja, director and senior consultant, medical oncology, MGM Cancer Institute, says, “People think that only people with fair skin or older people get skin cancer, which is not true.” He notes that melanoma can occur “in people of any skin tone even in non-sun exposed areas like the palm of the hand or the underside of the foot.”

The ABCDE rule

The ABCDE rule: Asymmetry, Border irregularity, Colour variation, Diameter, and Evolving is commonly used to assess moles.

“The ABCDE rule is a useful reference point, it is not, however, a definitive test,” says Dr. Nasika. She emphasises that in darker skin tones, many lesions may not clearly fit these criteria. The most important sign, she notes, is change over time: “‘E’ for evolving any new characteristics after a period should be concerning.”

When to seek medical care

Doctors advise that the decision to consult a specialist should be based on change rather than severity. “If a mole becomes larger, thicker, changes shape or stays about the same in appearance but feels different to other moles, you should seek medical advice,” says Dr. Nasika.

Dr. Raja also highlights a key misconception “Perhaps the biggest myth about melanoma is that they happen in moles. In fact 80% of melanomas come where there are no moles.” He adds that the likelihood of a mole turning cancerous is low, “approximately 1% of moles might transform to melanoma.” Despite this, early detection remains crucial, as melanoma can become life-threatening if diagnosed late.

Risk factors and myths

Environmental and lifestyle factors can influence skin health over time. Dr. Nasika notes that “UV exposure, environmental toxins, and repeated movement of the skin, due to pressure of clothing can affect moles.”

Dr. Raja warns against misconceptions around sun exposure: “Tanning is not protective. In fact, tanning beds increase the risk of melanoma by 75%. People also think that sunscreen is not needed on cloudy days but 80% of UV light can come through even on cloudy days.” He recommends avoiding excessive sun exposure and using sunscreen with at least SPF 30 on all days.

Awareness and early detection

A major challenge remains delayed response to early signs. “Many people still believe ‘it’s just a mole’ and do not respond when a mole grows larger, changes colours or has a different texture,” says Dr. Nasika. She adds that the misconception that darker skin is not at risk has contributed to delayed diagnosis in India.

“Any changes, especially in darker-skinned individuals, should be investigated,” she says.

Dr. Raja advises regular self-examination: “Do regular skin self-examination, once every 1 to 2 months, changes in the colour, changes in the border, whether there is any asymmetry -- all those things are important.” He also notes that a healthy diet rich in fruits and vegetables may offer some protective benefits.

In melanoma, early recognition of change can make a significant difference. What appears minor today may be the first sign that warrants medical attention.