Early diagnosis and excision of melanoma during pregnancy key to better outcomes

Melanoma should be identified during pregnancy and then excised, since a delay in management may create an opportunity for a melanoma to advance. That’s according to Dr. Jane Margaret Grant-Kels, Professor of Dermatology, Pathology and Pediatrics, University of Connecticut School of Medicine, Farmington, Conn.

Speaking at a session on the evaluation and treatment of pregnant patients at the annual meeting of the American Academy of Dermatology (AAD) in Denver, Dr. Grant-Kels discussed how clinicians should assess and manage nevi and melanoma when they present in a pregnant patient. She is also the Founding Director of the Cutaneous Oncology Center & Melanoma Program at the University of Connecticut Health Center. She will be installed as president-elect of the AAD in March 2027.

One key takeaway for clinicians is that nevi should not change physiologically during pregnancy, which goes against previous teachings, according to Dr. Grant-Kels. “Obviously nevi on the breast and abdomen can enlarge or stretch as those areas enlarge during pregnancy, but other than that, changes should be evaluated carefully.”

Dr. Grant-Kels pointed out that recent studies have shown that melanoma is now one of the most common malignancies that occur during pregnancy. Others include breast, cervical, thyroid and lymphomas/leukemias. But of all cancers, melanoma has the highest potential of metastasizing to the placenta and, more rarely, to the fetus.

“This is why you want to diagnose a melanoma in a pregnant woman as early as possible; you do not want to put the baby at risk, and you also want to treat the mom’s melanoma as early as possible so that the baby has a mother for its life,” said Dr. Grant-Kels. “That is an important message to convey.”

Dermoscopy is a key tool that should be used to help diagnose melanoma in a pregnant patient, allowing a dermatologist to detect features that suggest a potential melanoma, stressed Dr. Grant-Kels.

“If the lesion looks suspicious for a possible melanoma with the dermatoscope, you should biopsy the lesion as you would in any other patient,” said Dr. Grant-Kels.

There may be a theoretical concern that women who get a diagnosis of melanoma while pregnant may have a worse outcome compared to women who are not pregnant and have a melanoma diagnosis. However, data from at least seven studies that compared pregnant women with a diagnosis of melanoma to control subjects who were not pregnant and had a melanoma diagnosis found no significant difference in survival between the two groups, suggesting pregnancy does not adversely affect prognosis, said Dr. Grant-Kels.

To prevent a delay in diagnosis, Dr. Grant-Kels examines her pregnant patients with a family history or personal history of melanoma or a personal history of many dysplastic nevi every trimester.

If a woman does have a thin nonulcerated melanoma during pregnancy, it generally does not warrant deferring a future pregnancy, said Dr. Grant-Kels, citing a pooled analysis of 10 case-control studies (Cancer Causes Control 2008 Jun; 19(5):437-442).

This article is an excerpt from a longer article by Allan Ryan published in the Sept. 2026 issue of The Chronicle of Skin & Allergy.