Melanoma during pregnancy common, but treatable

Caitlyn Scaggs was 26 weeks pregnant with her first child when she asked her husband for a massage to alleviate her back pain.

“I remember him saying, ‘That spot on your back doesn’t look right’,” Scaggs, who lives in Christianburg, Va., said.

Their OB-GYN had already told them to monitor the mole, but Scaggs, then 24, didn’t mention it at her next visit. Then, her husband went with her and asked the doctor to look at it. Her doctor agreed the mole should be removed and sent her to a dermatologist, who removed and biopsied the growth.

“I was mind blown that anything could be wrong with me or my skin,” Scaggs said, noting that she lived a healthy lifestyle.

When her doctor called with the results, panic set in.

“When he said the word ‘melanoma,’ the floor dropped out. The idea that something is wrong with me that could hurt [my daughter] or something’s wrong with me that could impact her having a mommy one day, it was unbearable,” she recalled.

The good news was that the melanoma, which was .74mm in depth, was an early stage cancer and her pathology looked promising. The next day, Scaggs met with her surgeon and within a week she had wide excision surgery to remove the melanoma.

Although she doesn’t have a family history of skin cancer, Scaggs thinks her melanoma diagnosis was likely a result of a history of sitting out in the sun and using tanning beds before special events.

“I never burned and I thought because I wasn’t burning, my skin was OK and that’s not true,” she said.

About 1/3 of melanoma cases are in young women
“Having melanoma diagnosed during pregnancy is not a rare event,” said Dr. Lynn Schuchter, chief of the division of hematology oncology at the Abramson Cancer Center at the University of Pennsylvania Medicine in Berwyn and Philadelphia.

In fact, almost one-third of melanoma cases are diagnosed in women during their childbearing years, according to the American Academy of Dermatology.

What’s more, women diagnosed with melanoma during or shortly after pregnancy are significantly more likely to have tumors spread to other organs and tissues, and are also much more likely to have the cancer recur after treatment, a recent study in the Journal of the American Academy of Dermatology found.

The five-year survival rate for early stage melanoma is 98 percent, but for stage III cancer, it’s 78 percent.

Advanced stage melanoma is also one of the few types of cancer that can cross the placenta, although it’s rare, said Dr. Keith LeBlanc Jr., a dermatologist and a Mohs surgeon in the New Orleans area. In fact, between 1966 and 2002, there were only 87 such cases, according to a study published in the Journal of Clinical Oncology.

Hormones mean cancer?
Although it’s not clear why melanoma is common during pregnancy, experts say there are plausible causes.

Data has shown that certain melanomas have estrogen and progesterone receptors, which could potentially cause melanoma to grow more rapidly.

Another theory is that because the immune system is altered during pregnancy in order to prevent rejection of the fetus, the very same changes that suppress the immune system could lead to melanoma.

One of the problems with identifying melanoma during pregnancy is that  normal skin changes  might be mistaken as skin cancer— not to mention that an increase in pigmentation is more common during pregnancy.

“Even normal moles are going to change slightly during pregnancy,” LeBlanc said.

Melanoma treatment options
Unlike basal cell carcinoma and squamous cell carcinoma, which are less serious and less aggressive forms of cancer, experts say women who are diagnosed with melanoma must have surgery immediately to remove it.

A biopsy looks at the depth of the melanoma under a microscope and checks for certain features to determine how serious it is.

If the melanoma is thin enough, wide excision surgery, which removes the melanoma and the surrounding normal skin, will be done.

“The amount of normal skin around it depends on how deep the melanoma is,” Dr. Alicia M. Terando a surgical oncologist at the Ohio State University Comprehensive Cancer Center in Columbus.

In general, melanomas that are at least 1 mm in depth would have a significant chance of metastasis to the lymph nodes. In that case, a procedure called a sentinel lymph node biopsy is performed. A CAT scan may also be used to see if the melanoma has spread, Schuchter said.

The safest time during pregnancy to do surgery is during the second trimester, but if the cancer is found during the first trimester, the physician may perform a wide excision surgery and then sentinel lymph node biopsy in the second trimester.

For stage 3 and stage 4 melanomas, the primary treatment for melanoma is immunotherapy, but it isn’t deemed safe in pregnancy.

After pregnancy, waiting between two and three years to become pregnant again is a good idea because studies show melanoma can re-develop within this time period.  Some research suggests waiting five years, LeBlanc said.

For women who have already been diagnosed with melanoma or have a family history, they should get frequent skin checks during pregnancy.

“Bring the attention of any new mole or changing mole to your obstetrician, see a dermatologist for anything concerning and don’t wait and postpone until after the baby is born,” Schuchter said.

Since surgery, Scaggs has had two abnormal moles and 10 lesions removed. She has also had another child, now 2 years old.

“If I see anything that looks like it’s starting to change, we air on the side of removing it rather than leaving it,” she said.

She also goes to her dermatologist every six months for skin checks, is vigilant about wearing sunscreen every where she goes, and sits in the shade when she’s at the beach with her family.

“While I’m very careful about skin care, I also refuse to let melanoma steal my joy in life,” she said.