Pregnancy and Melanoma
I remember the first time my wife was pregnant. It was an amazing time for us. We worked on the nursery and chose “Classic Pooh”. We loaded up on Blue’s Clues videos. It was during the 1990’s and there were a lot of books out about what to expect when expecting. I took a very active role during those months leading up our son’s birth. Much of the medical content revolved around recommendations that seem commonplace now. Don’t smoke, don’t do drugs, eat well, gain a certain amount of weight, etc. I don’t recall anything about skin checks and melanoma.
What about now? A recent article in Dermatology Times gives some great insight. According to the article, renowned French dermatologists recommend that any changing lesion be excised and biopsied immediately. Changes in hormone levels can affect melanoma tumors, which can increase melanocyte stimulation and increase pigmentation. Pregnancy also “induces a state of immunosuppression, which decreases tumor surveillance and allows tumor progression.”1
Changing moles an area of concern?
Many clinicians have held that with pregnancy comes common changes in moles. The article points out that there are some slight transient dermoscopic changes in nevi (moles) during pregnancy, but that normal nevi should only experience slight and non-significant changes in the front of the body. As a woman’s skin stretches, the appearance of nevi will naturally be affected to a certain degree. The French doctors state that there is no evidence to show that there is a darkening of moles during a woman’s pregnancy, which has been a common misconception.1
Bottom line is this. Changes that occur in moles during pregnancy should not be ignored as simply a natural consequence of pregnancy. Any mole that may look like melanoma should be treated as such. If one is not sure, get it checked out. The article argues that the low dosages of lidocaine and epinephrine used in common biopsies are safe and can be used at all stages of pregnancy.1
Traditionally, doctors have believed that women who have been diagnosed with melanoma during pregnancy have poorer prognoses. Yet, the article contends that pregnancy-associated melanoma (PAM) prognoses do not appear to be worse than non-pregnancy controls. Diagnostic imaging measures should be closely monitored to protect the fetus. According to Dr. Marie Aleth Richard reporting at the European Academy of Dermatology and Venereology (EADV) Congress, “All surgical procedures can be done safely during pregnancy. Biopsy, excision and flap closure can all be done in the first trimester of pregnancy. Local anesthesia can be used in all these situations.” 1
Information is critical
In terms of best practice, Dr. Richard concludes that treatment of stage 1-3 melanomas should be the same in pregnant and non-pregnant patients. She continues to recommend that melanomas with nodal involvement be treated on a case-by-case basis based on the mother’s wishes (as long as she has enough information to make an informed decision regarding treatment.)
Regular routines serve best
So, what does this all mean? In summary, pregnant women should practice safe skin care practices like their non-expecting counterparts. This means skin checks, consulting physicians, and safe treatment based on the best, current information. Not sure if this will ever make it in the books about what to expect when one is expecting, but clarity regarding skin care is always good news.
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