Melanoma and pregnancy

Do not delay assessment of a changing lesion

Pregnancy can alter skin pigmentation and appearance, but a growing, bleeding or suspiciously changing spot should not automatically be attributed to hormones. Dermatological examination and dermoscopy are possible; an indicated skin biopsy can be performed during pregnancy with appropriate precautions. Always tell the clinician about pregnancy and current medicines.

Historical statements suggesting that one third of the most serious melanomas occur in pregnant women are not a usable estimate for an individual patient. Risk and prognosis primarily depend on tumour characteristics and stage. Pregnancy is not a reason to postpone diagnosis of a suspicious lesion until after birth.

Localised melanoma can be treated surgically during pregnancy. Dermatology, surgery, oncology and obstetrics teams should agree a plan considering gestational age and maternal and fetal needs. Anaesthesia, the setting of the procedure and monitoring are selected for the circumstances rather than imposed through one rule for everybody.

Sources: AAD — Melanoma during pregnancy; NICE NG14 — melanoma, recommendations.

Staging, treatment and the baby’s care

When investigations of disease extent are needed, the team chooses timing and methods suitable for pregnancy. Sentinel node biopsy requires discussion of its informational benefit, possible delay and procedural risks; NICE explicitly includes discussing postponement until after pregnancy. Tracers and dyes are not selected by patients themselves. MRI may have a role, but use of contrast also needs individual assessment.

Advanced disease involves particularly complex multidisciplinary decisions. Immunotherapies and targeted medicines cannot be described as safe in pregnancy simply because they are effective outside pregnancy. The product information, alternatives and possible timing must be reviewed alongside the woman’s preferences. Generic online advice cannot replace this discussion.

Transmission of melanoma through the placenta is rare. Examination of the placenta may be appropriate in advanced maternal disease; placental involvement calls for specialist neonatal and paediatric follow-up. Historical percentages from small case collections must not become personal risk estimates or an automatic X-ray schedule for every newborn.

Sources: NICE NG14 — melanoma, recommendations; AAD — Melanoma during pregnancy; NCI — Melanoma Treatment (PDQ).

Pregnancy after melanoma, contraception and breastfeeding

A past melanoma does not automatically rule out a future pregnancy. Before planning conception, discuss stage, recurrence risk, current or completed treatment and the required interval after the last medicine. There is no single waiting period for everyone. If treatment could affect fertility, discuss preservation before starting whenever possible.

Contraception and breastfeeding advice must reflect the actual medicine and clinical history. A removed melanoma is not a permanent ban on breastfeeding, but breastfeeding may be contraindicated during certain therapies and for a period afterwards. Do not discontinue treatment without contacting the centre. Bring reproductive wishes, concerns and any need for psychological support to the consultation so that decisions are genuinely shared.

Sources: AAD — Melanoma during pregnancy; NCI — Melanoma Treatment (PDQ).