May 1, 2023 – Research shows that 1 in 1,000 women will be diagnosed with cancer during pregnancy, and melanoma is the most common cancer these patients will be diagnosed with. This form of skin cancer can be deadly if not caught early.Studies show that one-third of melanoma cases are diagnosed in women of childbearing age.
Melanoma detection is especially important for expectant mothers. This is because hormonal changes that occur during pregnancy may affect skin cells, speeding up the growth of melanoma and potentially causing it to spread to other places in the body.
“Pregnancy lowers a woman’s immunity, which may permit malignant cells to proliferate if present,” said Anna C. Pavlick, DO, founding director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian and associate director for clinical research at Weill Cornell Medicine's Meyer Cancer Center in New York City. “Some melanomas also harbor estrogen receptors which can be stimulated with pregnancy.”
The good news: Doctors can safely remove and treat melanoma during pregnancy, so a woman at risk should definitely be checked for the disease before and during her pregnancy.
“Patients with pregnancy-associated melanoma do not seem to have a worse prognosis than those with melanoma not diagnosed around the time of pregnancy,” said William Dahut, MD, the chief scientific officer for the American Cancer Society.
Read on for a look at every life-saving fact you need to know, and outline the latest research and treatment options.
What Is Melanoma?
“Melanoma is an aggressive form of skin cancer that develops within the skin cell that makes melanin, which is the pigment that makes up skin tone,” said Danilo C. Del Campo, MD, a board-certified dermatologist at the Chicago Skin Clinic. “When these cells become cancerous, they rapidly grow and easily spread to other areas in the body.”
According to the American Academy of Dermatology, melanoma can develop from a mole that's already on your skin, or it may appear suddenly as a new lesion.
“While one-third of melanomas arise in existing moles, two-thirds of melanomas arise in healthy skin,” said Lauren Ploch, MD, a board-certified dermatologist in private practice in Aiken, SC, and Augusta, GA.
Melanoma can be on any part of your skin.
“It can also be found in your eyes, mouth, and genitalia,” said Ross Radusky, MD, a board-certified dermatologist at the Dermatology Treatment & Research Center in Dallas.
What Are the Symptoms of Melanoma During Pregnancy?
The symptoms of melanoma in pregnancy are the same you’d look for if you weren’t expecting.
According to the Mayo Clinic, the “ABCDE” method can help you identify a possible melanoma lesion on your body:
- A is for asymmetrical. Moles with irregular borders, like two halves that look distinctly different, are suspicious.
- B is for irregular border. Look for moles with irregular, scalloped, or notched edges.
- C is for changes in color. Melanoma can be multi-colored, or its color can look uneven.
- D is for diameter. New growth in a mole that’s bigger than a quarter-inch warrants attention.
- E is for evolving. Is a mole growing, changing color, or shifting shape? These are potential signs of melanoma, along with new itching or bleeding.
“Most melanomas are dark and grow rapidly,” said Ploch. “However, melanomas can also be colorless. I recommend that anyone seek care from a dermatologist if they have any spots that are new or changing in size, shape, color, or character. Self-screening for new or changing spots is very important, and everyone should check themselves every 3 months.”
Pregnant women should be extra diligent about checking certain parts of their bodies.
“Melanomas can also sometimes be missed, especially on the belly and back, because as a woman progresses into her third trimester, that extra stretch and growth can hide concerning spots for skin cancer,” said Radusky. Ask your partner or a friend to check areas you can’t see.
Can a Woman Pass Melanoma to Her Baby During Pregnancy?
Melanoma can become metastatic across the placenta, which does mean a baby can be born with the disease if it's left untreated. But “it’s extremely rare for melanoma to affect the baby,” said Del Campo.
According to the American Academy of Dermatology, if a mother has advanced melanoma, the placenta can be checked for the disease. Should melanoma be detected, her baby can then be examined and watched by a dermatologist for any symptoms.
As a precaution, some melanoma patients should not get pregnant, either for the first time or again, for a period of time.
“If a woman is diagnosed with a high-risk melanoma prior to a pregnancy, most oncologists will recommend waiting 2 to 3 years to determine if the patients will have recurrent disease before pursuing pregnancy,” said Pavlik. Women diagnosed at an early stage with a good prognosis don’t have any restrictions.
Can a Woman Be Safely Treated for Melanoma During Pregnancy?
Yes, said Ploch.
"The vast majority of melanomas are treated by excision as an outpatient,” she said. “This can be done anytime during pregnancy.”
If melanoma is caught early, a mother-to-be can have this procedure and most likely have an excellent outcome.
If a pregnant person is diagnosed with melanoma at a more advanced stage, other treatment is available as well. Usually, if doctors feel melanoma is deep in the skin, a special test called sentinel lymph node biopsy (SLNB) can determine if it has spread.
“Sentinel lymph node biopsy is controversial, as it employs isosulfan blue dye, which has a high risk of allergic reactions, as well as Technesium 99, a radioactive metal," said Pavlik. Most of the time, ultrasound monitoring will be done instead.
“Systemic agents used in advanced or metastatic melanoma may cause harm to an unborn child, such as combination BRAF plus MEK inhibitors and checkpoint inhibitor immunotherapy,” said Dahut. Ask your doctor to explain in-depth about the treatment options that are right for you specifically.
Most important of all: A pregnant patient who is diagnosed with melanoma needs ongoing care and evaluation.
“Pregnant melanoma patients should be closely followed by a multidisciplinary team consisting of a surgical oncologist, medical oncologist, and dermatologist,” said Pavlik. Stay proactive about your health, and you’re doing everything you can to protect yourself and your baby.