Americans tend to think of melanoma as a cancer that strikes the skin of the middle-aged or the elderly. However, experts estimate that as many as one third of the cases of the most serious cancer occur in women during their childbearing years.
According to WashingtonFAMILY Magazine, as women tend to postpone having children until their 30s or 40s, the chances of developing this malignancy while pregnant are growing. Adding to this trend is the fact that among those between 25 and 29, melanoma is the most common type of cancer.
Attendees at the 67th Annual Meeting of the American Academy of Dermatology heard evidence relating to the fate of women who developed melanoma during their pregnancies as well as those who became pregnant after surviving the malignancy. The effect of hormones on melanoma has been the subject of controversy among medical professionals for years.
Some researchers believe that when the hormones linked to pregnancy are present, melanomas grow quickly and spread to other areas of the body. A presentation by Marcia Driscoll, M.D., a member of the dermatology faculty at the University of Maryland School of Medicine, stressed that a review of research suggests otherwise. She reported that this review shows no evidence that pregnancy has an adverse effect on either the prognosis of melanoma or the risk level of developing the condition.
Driscoll added that the evidence regarding becoming pregnant after receiving a melanoma diagnosis derives from three small case-controlled studies. She said that after researching this area for 15 years, she has found no solid link between hormones and melanoma.
She indicated that the most important factor in counseling a woman who has had melanoma regarding future pregnancies is her prognosis. This is based upon the woman’s stage of the disease. Staging for melanoma considers tumor thickness, the presence or absence of ulceration and whether the cancer has spread to the patient’s lymph nodes or other organs. To have a very good prognosis, a woman would need a tumor less than 1 mm in depth, no ulceration in the tumor and disease that has been contained and not spread.
Driscoll said that when counseling women who have survived melanoma about future pregnancies, she advises those with an excellent prognosis that there is no reason to delay a pregnancy. For patients whose tumors are more than 1 mm deep, she advises a delay of two to three years since this is the most typical time in which melanoma can recur. She said that women with advanced melanoma that has already spread have a much poorer prognosis and a much more complex situation to address regarding their survivability.
If a doctor diagnoses a melanoma during or after a pregnancy, additional data suggest that the pregnancy won’t affect the woman’s prognosis. Driscoll adds that it’s rare for the infant to be affected, as this usually happens only when the mother has advanced melanoma that has spread throughout her body.
For a localized melanoma, a pregnant woman receives the same treatment as that given to other patients. Doctors use a local anesthetic. If the case requires a wide local excision in later stages of the pregnancy, an obstetrician might assist the dermatologist by monitoring the fetus.