Melanoma risk significant among pregnant women

The rising melanoma risk among women of child-bearing age is greatest in women younger than 50 who are pregnant or were recently pregnant, Cleveland Clinic researchers report in a new study.

The study highlights the need for regular skin checks and self-examinations among women younger than 50. Those diagnosed with melanoma during or within a year after childbirth should have regular follow-up and monitoring for recurrence of the skin cancer.

Researchers in Cleveland Clinic’s Dermatology and Plastic Surgery Institute referred to a clinical database of electronic medical records to collect detailed data of cutaneous melanomas developing in 462 women ages 49 years and younger.

They found that women diagnosed with malignant melanoma during their pregnancy or within one year of giving birth were 5.1-times more likely to die, 6.9-times more likely to experience metastasis, and 9.2-times more likely to have a recurrence than a control group of non-pregnant women, according to a press release about the study.

The study’s primary investigator Brian Gastman, M.D., a plastic surgeon and director of melanoma surgery at Cleveland Clinic, called the rate of metastasis, recurrence and death “astounding.”

Dr. Gastman told Dermatology Times, “The two groups that were compared were of similar age, similar histology, similar race and of course all were female. It was only the pregnancy that we found a distinctly high-risk population.”

Making the connection

The researchers believe natural changes during pregnancy might fuel melanoma.

“We did use some basic science studies to conjecture why this is happening. Women in and after pregnancy not only go through major hormonal changes, but also changes in their immune system,” Dr. Gastman says. “These combined changes probably account for these findings, but our group is actively studying this question in the laboratory.”

In practice

Key points for dermatologists, according to Dr. Gastman, are:

Melanoma is increasing in prevalence among young women, making this an at-risk population, in general.

Once in adulthood, these women should have a lower threshold to develop a relationship with a dermatologist, especially if they have more than 50 moles. Even without a personal or family history of skin cancer or more than 50 moles, they need to be vigilant for changing moles on their body.

If they do have a history that predisposes them to melanoma, when they become pregnant and at least a year afterwards, they should have more frequent evaluations of their skin, ideally by a dermatologist, or at least a primary care doctor and, of course, self-exam is key, too.

The impact for OB/GYNs

The study’s findings also have implications for OB/GYNs, according to Salena Zanotti, M.D., an OB/GYN at Cleveland Clinic.

“Many women only see an OB/GYN during their reproductive years and only get a physical examination during pregnancy,” Dr. Zanotti says. “This study highlights the importance of a complete physical examination of pregnant women when they present for their initial visit that would include a skin examination," she says.

"As many women are delaying childbirth into their 30s and 40s, it makes sense that more pregnant women will be found to have certain cancers such as breast cancer, and in this case melanomas. The more aggressive nature of these melanomas in pregnancies strongly supports the importance of a skin examination during this time,” Dr. Zanotti adds.

OB/GYNs should consider referring women with many moles to a dermatologist — if those women haven’t been examined in over a year or if there are any concerning findings, according to Dr. Zanotti.

“Routine skin examinations are not done postpartum. These findings suggest that this practice may need to change,” Dr. Zanotti says. “This study also supports the importance of counseling about skin cancer prevention in women in all decades, particularly the second and third decades, which is also a time when the gynecologist may be the only physician seeing these women.”