Introduction
Pregnant women might notice the emergence of new moles or other skin marks during pregnancy. While most of these changes are typically harmless, it is important to be aware that melanoma, a form of skin cancer, can also develop during this time. If any skin marks raise concerns, it is good to consult with a healthcare professional for a thorough evaluation and guidance. Read this article to explore more.
What Are Moles?
Moles, or nevi, are a prevalent form of skin growth characterized by small, dark brown spots resulting from clusters of pigment-forming cells known as melanocytes. Typically, individuals develop ten to 45 moles during childhood and adolescence, and the appearance of these moles may evolve and fade over time. While most moles are benign and pose no threat, there is a rare chance of them becoming cancerous. It is difficult to stay vigilant and observe any changes in the appearance of moles and pigmented patches, as this awareness is essential for detecting skin cancer, particularly malignant melanoma. Regular monitoring ensures early identification and appropriate medical attention if needed.
What Are the Causes of Moles in Pregnancy?
During pregnancy, hormonal shifts, particularly in estrogen and progesterone levels, can lead to the development of new moles. These hormones play a role in stimulating melanocytes, which are responsible for producing the pigment melanin. As a result, pigment is increased, which is a natural coloring substance in the skin. Melanin contributes to the skin's natural color and is responsible for skin pigmentation. Consequently, moles tend to emerge in areas with a concentration of these pigment-producing cells in the skin.
When Should a Woman Become Concerned About Changes in a Mole’s Appearance?
If a mole grows larger during pregnancy, it typically undergoes symmetrical changes. However, paying attention to any unusual, irregular, or uneven alterations in size and color is essential. For areas that are challenging to examine, utilize a mirror or seek assistance from one’s partner or a friend. While most moles are harmless, it is crucial to consult the doctor if one is worried about a new mole or any changes in an existing one. The ABCDE checklist offers a straightforward guide:
-
A for Asymmetry: Check for uneven or irregular shapes. Benign moles are generally symmetrical.
-
B for Border: Be cautious if the mole has a ragged or irregular border. Most moles have a clear, smooth edge.
-
C for Color: Look for uneven coloring with shades like black, red, pink, white, or a blue tint. Normal moles usually have various shades of brown.
-
D for Diameter: Pay attention to whether the mole is bigger than the diameter of a pencil. Benign moles are typically smaller.
-
E for Evolving: Monitor for any changes in size, shape, color, or height.
Keep an eye out for the following signs in one’s moles:
-
Bleeding or Crusting Over: If a mole starts bleeding or develops a crust, seeking medical attention is advisable. These changes indicate an underlying issue that requires evaluation.
-
Tingling or Itching: Persistent tingling or itching in a mole can cause concern. While occasional itching is common, continuous discomfort should be addressed with a healthcare professional.
Why Does the Appearance of Mole Change During Pregnancy?
Observing changes in moles during pregnancy is common, and most of these alterations are normal and harmless. Minor changes, especially in the size of moles on the breasts and abdomen, can occur due to the stretching of the skin in these areas. This is particularly noticeable if atypical mole syndrome is characterized by a higher number of moles, including those already unusual in size, shape, or color.
Moles in other body parts, like the back and legs, typically remain the same size. Increased blood supply during pregnancy may subtly affect some moles, but these changes differ from those associated with malignant (cancerous) moles. In most cases, these alterations revert to their pre-pregnancy state within approximately a year after giving birth. It is important to note that moles or freckles should not darken in color during pregnancy. If one experiences color changes, it may occur in other areas of one’s skin, such as the nipples, face (melasma), or abdomen (linea nigra).
What Is Pregnancy-Associated Melanoma, and Who Is at Risk?
Melanoma is a form of skin cancer originating from pigment-producing cells known as melanocytes. It can manifest as a new mole or transform an existing mole into a cancerous one. Pregnancy-associated melanoma refers to melanoma diagnosed during pregnancy or within the first 12 months after delivery. Globally, the reported incidence of pregnancy-associated melanoma ranges from ten to 26 cases per 100,000 pregnancies, constituting five to eight percent of pregnancy-associated cancers. In Australia, melanoma represents a third of malignancies diagnosed during pregnancy, with an incidence of 52 cases per 100,000. This higher incidence in Australia may be linked to increased maternal age. The signs and symptoms of melanoma in pregnant women are identical to those observed in non-pregnant women. To assess any changes, one can utilize the ABCDE rule mentioned above.
What Is the Treatment for Melanoma During Pregnancy?
After confirming melanoma through an initial complete excisional biopsy, the standard practice involves wide local excision around the initial surgical site. Suppose surgery requiring general anesthesia cannot be delayed. Performing it during the second trimester is safest, while anesthesia use should be minimized in the first trimester. Staging, crucial for understanding the extent of the disease, may involve ultrasound and magnetic resonance imaging (MRI) during pregnancy. Computerized tomography (CT) can be considered if necessary, weighing benefits against potential risks.
-
Sentinel Lymph Node Biopsy: While sentinel lymph node biopsy provides prognostic information, it is challenging to justify during pregnancy. A technetium radioactive tracer alone is recommended if deemed essential for treatment planning.
Systemic treatment options for advanced melanoma during pregnancy are as follows:
-
BRAF Inhibitors:
-
Vemurafenib: Appears safe based on animal studies, but limited human data.
-
Dabrafenib: Considered teratogenic, posing a potential risk to the fetus.
-
MEK Inhibitors:
-
Ipilimumab: Shows good outcomes with no apparent harm to the newborn, though increased fetal loss is reported in animal studies.
-
Trametinib: Can harm the fetus.
-
Cobimetinib: Poses a risk based on animal studies and its mechanism of action.
-
PD-1 Pathway Immune Checkpoint Inhibitors:
-
Nivolumab: Not recommended during pregnancy based on animal studies.
-
Pembrolizumab: This crosses the placenta, may increase the risk of autoimmune disorders, and poses a potential risk to the fetus.
Conclusion
In conclusion, while changes in moles during pregnancy are often normal and benign, expectant mothers must stay vigilant. Any significant alterations in mole size, shape, color, or associated symptoms should prompt consultation with a healthcare professional. Pregnancy-associated melanoma, though rare, requires careful monitoring and timely evaluation through the ABCDE rule is essential. Treatment options for melanoma during pregnancy involve considerations for the safety of both the mother and the fetus, emphasizing the importance of a multidisciplinary approach in managing this complex situation.
