By Arielle Grabel and Becky Kamowitz
In previous posts we’ve talked about pregnancy and skin cancer risk and what happens when you’re diagnosed with advanced melanoma during pregnancy. Now we’re focusing on the potential risks of getting pregnant after a melanoma diagnosis. Melanoma is one of the most common cancers diagnosed in women in their 20s and 30s, when many women are thinking about starting or expanding their families. A history of melanoma doesn’t automatically mean pregnancy is off the table, but there are factors to consider.
First, a crucial caveat: If you are thinking about getting pregnant after any kind of cancer treatment, be sure to consult with your medical team first. They can make a recommendation based on your age, overall health and likelihood to conceive.
At What Stage Was the Melanoma Diagnosed?
The stage of melanoma is determined by several factors, including how much the cancer has grown and whether the disease has spread (metastasized). Receiving treatment for an early stage melanoma (localized tumors that are generally defined as stage 0 – “in situ”— or stage I) does not affect your chances of getting pregnant after the treatment is complete, nor would it pose risks to you or the baby after you conceive. These are usually curable skin cancers, typically treated with excisional surgery. “If the tumor has little to no risk of metastasizing, there is no need to delay pregnancy,” says Marcia Driscoll, MD, PharmD, associate professor of dermatology at the University of Maryland School of Medicine.
Stage II melanomas have not spread beyond the original tumor but are at higher risk of doing so; stage III melanomas have spread to local lymph nodes; and stage IV melanomas have spread to distant organs. If your melanoma is diagnosed at one of these stages, even if you’ve been treated successfully and are in remission, your doctor may recommend delaying pregnancy due to the potential of recurrence – the risk that the cancer will come back.
How Likely Is the Melanoma to Recur?
Most melanoma recurrences happen within two to three years of initial diagnosis, so someone with a higher stage melanoma may want to delay pregnancy.
While Dr. Driscoll assures us that while there is no evidence pregnancy increases the risk of melanoma recurrence, having a high-risk or advanced stage melanoma does. “Most melanoma recurrences happen within two to three years of initial diagnosis, so someone with a higher stage melanoma may want to delay pregnancy,” she says. High-risk and advanced stage melanomas may require treatments that would be harmful to a growing fetus. Likewise, delaying treatment until after the baby is born can be deadly for the mother.
Because of the risk of recurrence, high-stage melanoma diagnoses may require routine monitoring with regular CT scans, which are not advisable during pregnancy. “This is a big ‘no’ during pregnancy, as ionizing radiation is harmful and can cause birth defects,” says Sapna Patel, MD, associate professor of melanoma medical oncology at The University of Texas MD Anderson Cancer Center. So, a mom-to-be would have to be willing to forgo CT scans during her pregnancy.
How Was the Melanoma Treated?
Many advanced melanomas are treated with immunotherapy. While these therapies can be lifesaving, they may make it harder to become pregnant. “There is a 5 to 15 percent risk that immunotherapy can permanently disrupt hormones, menstrual cycles and thyroid function, which can lead to long-term fertility effects,” says Dr. Patel. But she cautions that there are still a lot of unknowns about the long-term side effects of these medications because they are so new. No matter what kind of treatment you receive, be sure that your medical team fully explains the potential risks and side effects first.
JB, a 34-year-old woman and a patient of Dr. Patel’s (who prefers that her full name not be used), underwent months of treatment for melanoma, including radiation, chemotherapy and immunotherapy, which caused her body to go into early menopause. “I’m cancer-free, but my chances of getting pregnant again are pretty low,” she says. She is still working with Dr. Patel and her medical team to explore other options. “If you are going through immunotherapy and interested in having a child afterward, speak to your medical team about fertility options like freezing eggs or sperm banking,” says Dr. Patel.
The Bottom Line: Talk to Your Medical Team First
Ultimately, based upon a large Swedish population-based cohort study, “There is no difference in survival between women who became pregnant within five years of their malignant melanoma diagnosis and nonpregnant women of the same age,” says Dr. Driscoll. But she stresses that for people who have been treated for high-risk or high-stage melanoma, the decision to become pregnant should be made on a case-by-case basis, with the support of your medical team, including your obstetrician, surgical oncologist and dermatologist.
Keeping Kids (and Yourself) Sun Safe
Although melanoma accounts for only 1 percent of all cancers in children from birth to age 14, if you have a history of melanoma or any type of skin cancer, your children will have an increased risk of developing the disease. Follow a sun protection strategy for your children and check their skin regularly for anything new, changing or unusual. Let your pediatrician know about your skin cancer history; the doctor may suggest your child receive regular skin exams with a pediatric dermatologist. Finally, remember that it’s just as important to protect yourself after a diagnosis, so be sure to use these tips daily.