Kavita Mariwalla, MD
Dr. Mariwalla is the Director of Dermatologic Surgery, Continuum Cancer Centers of New York, New York.
Dr. Mariwalla reports no conflicts of interest in relation to this post.
A recent study in BJOG: An International Journal of Obstetrics and Gynaecology has attracted attention in the last few weeks. The authors studied 781,907 women in New South Wales, Australia, from 1994 to 2008 (approximately 1.3 million pregnancies) and found an increase in cancer diagnoses during pregnancy. The results showed that from 1994 to 1997 the crude incidence rate of pregnancy-associated cancer increased from 112.3 to 191.5 per 100,000 pregnancies. Because the study was conducted in Australia, of course one of the most common cancers was melanoma.
What’s the issue?
For me, the results bring up an interesting question: How do you properly screen a pregnant woman’s nevi? As dermatologists, we know that nevi darken during pregnancy. In my experience, most obstetricians and gynecologists I have spoken to prefer not to biopsy until after 16 weeks of pregnancy unless absolutely necessary (and of course without epinephrine). In my practice, if I find a worrisome pigmented lesion in a pregnant woman, I get clearance from the obstetrician to perform only a shave biopsy (as opposed to an excisional biopsy) with plain lidocaine to diagnose the lesion. I know that I may not be getting the entire depth of the lesion, but at least I get a diagnosis and can plan accordingly. If the result is a nevus with moderate or severe atypia, I wait until after delivery to excise. If it is something that requires more immediate excision, I coordinate with the obstetrician. However, I rely on my dermatoscope to examine pregnant women with darkening nevi more than any of my other patients. It is difficult and this study from Australia only makes me more vigilant. What do you do in your practice? Any tips for the rest of us?