Skin cancer more deadly when caught during pregnancy

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(Reuters Health) - Melanoma may be even more dangerous when it's diagnosed in women during pregnancy or within a year of giving birth, a U.S. study suggests.

Among women under 50 with malignant melanoma, those diagnosed during or soon after pregnancy were significantly more likely to have tumors spread to other organs and tissues, and were also much more likely to have the cancer recur after treatment, the study found.

Women diagnosed around the time of pregnancy were also more likely to die, though the risk increase wasn't big enough to rule out the possibility it was due to chance.

"This study demonstrated that women who are diagnosed with melanoma during pregnancy or in the post-gestation period have higher risk melanomas," said Dr. Jeffrey Farma, co-director of the cutaneous oncology and melanoma program at Fox Chase Cancer Center in Philadelphia, of the study, which was based on review of medical records for 462 women.

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Skin cancer more deadly when caught during pregnancy
MIAMI, FL - JUNE 15: Doctor Antonella Tost, Dermatologist University of Miami School of Medicine, examines Michael Casa Nova,12, for symptoms of skin cancer due to sun exposure on June 15, 2011 in Miami, Florida. The federal Food and Drug Administration announced that sunscreen manufacturers are to change the labels on their products to prohibit the use of certain marketing terms. The new rules are meant to help clear up confusion about the meaning of 'sun protection factor,' or SPF, and other terms like 'waterproof.' (Photo by Joe Raedle/Getty Images)
MIAMI, FL - JUNE 15: Doctor Jonette Keri, Dermatologist University of Miami School of Medicine, displays the underside of Amy Rey's arm in contrast to the top side to compare what the sun has done to the top side as she examines her for symptoms of skin cancer due to sun exposure on June 15, 2011 in Miami, Florida. The federal Food and Drug Administration announced that sunscreen manufacturers are to change the labels on their products to prohibit the use of certain marketing terms. The new rules are meant to help clear up confusion about the meaning of 'sun protection factor,' or SPF, and other terms like 'waterproof.' (Photo by Joe Raedle/Getty Images)
MIAMI, FL - JUNE 15: Amy Rey has a mark on her skin after a biopsy was performed on a lesion to check for cancer due to sun exposure on June 15, 2011 in Miami, Florida. The federal Food and Drug Administration announced that sunscreen manufacturers are to change the labels on their products to prohibit the use of certain marketing terms. The new rules are meant to help clear up confusion about the meaning of 'sun protection factor,' or SPF, and other terms like 'waterproof.' (Photo by Joe Raedle/Getty Images)
MIAMI, FL - JUNE 15: Amy Rey has freckles on her belly, as she gets a skin exam by a dermatologist at the University Of Miami School Of Medicine, she uses sun screen since she may be more susceptible to skin cancer due to her fair skin on June 15, 2011 in Miami, Florida. The federal Food and Drug Administration announced that sunscreen manufacturers are to change the labels on their products to prohibit the use of certain marketing terms. The new rules are meant to help clear up confusion about the meaning of 'sun protection factor,' or SPF, and other terms like 'waterproof.' (Photo by Joe Raedle/Getty Images)
In this photo taken on Jan. 26, 2012, in Aurora, Colo., Jodi Duke, a 35-year-old melanoma survivor living in Aurora, shows the scar left on her arm from melanoma. Duke used tanning beds as a teen and advocated for a bill regulating tanning that failed in 2007. Colorado is one of the last states to consider tanning bed limits for children. But a proposal this year to require parental notification for UV tanning beds may run into opposition from lawmakers who have vowed to shun regulation. (AP Photo/Ed Andrieski)
Katie Donnar, 18, shows her scar from where the melanoma was on the calf of her leg Thursday, Jan. 14, 2010 in Vincennes, Ind. in front of a tanning bed like the on she used at her home and at the tanning salons. Donnar was in the sixth grade when she started using tanning beds. (AP Photo/ Daniel R. Patmore)
A bandaged Sen. John McCain, R-Ariz., takes part in a Washington news conference to discuss campaign finance reform, Monday, Feb. 11, 2002. Last week, McCain had a cancerous lesion removed from the left side of his nose which was diagnosed as the earliest form of melanoma and was removed. (AP Photo/Stephen J. Boitano)
Freckle-faced Corey Halpin, 13, shows off his big scar at his Hanover Park, Ill., home on Monday, April 18, 2005, a reminder of surgery three years ago to remove a cancerous growth from his left arm. At age 10, doctors discovered melanoma on Corey's left arm, the most serious and potentially deadly form of skin cancer that until recently was almost unheard of in children. (AP Photo/Brian Kersey)
BOSTON - MAY 20: Melanoma survivor Elissa Campbell was photographed in the Back Bay in Boston, Mass. on Monday, May 20, 2013. This is the scar where the mole was removed on the back of Campbell's leg. (Photo by Yoon S. Byun/The Boston Globe via Getty Images)
BOSTON - MAY 20: Melanoma survivor Elissa Campbell was photographed along Commonwealth Avenue in the Back Bay in Boston, Mass. on Monday, May 20, 2013. (Photo by Yoon S. Byun/The Boston Globe via Getty Images)
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"Although this is a retrospective small series, I believe consideration should be made to screening some patients more closely," Farma, who wasn't involved in the study, said by email.

While the study doesn't examine why pregnancy might influence melanoma outcomes, it's possible that hormone fluctuations or suppressed immune system activity during this time help tumors flourish, said senior author Dr. Brian Gastman, director of melanoma surgery at the Cleveland Clinic in Ohio.

To explore how pregnant patients fared with this type of cancer, researchers analyzed records for women who were all aged 49 and younger when diagnosed with melanoma between 1988 and 2012. This group included 41 women who were diagnosed during or within one year of pregnancy.

On average, the women were around 35 years old at the start of the study, and they were typically followed for at least seven years. Most of them were diagnosed with stage 0 or 1 melanoma.

After treatment, 12.5% of the women diagnosed during or after pregnancy had the cancer return, compared with just 1.4% of the other women in the study.

Metastasis occurred in 25% of women diagnosed around the time of pregnancy, compared with 12.7% of the others.

More women diagnosed around pregnancy died - 20% compared with 10.3% of the others - but this difference wasn't statistically significant, the researchers report in the Journal of the American Academy of Dermatology, online January 20.

Because the study was based on patients at one medical center that tends to see more complex cases, it's possible the results are not representative of what all women with melanoma might experience, the authors note.

But the findings still suggest that doctors should advise pregnant women with melanoma to be hyper-vigilant about examining their skin for any changes or abnormalities and seek medical attention promptly if they see anything amiss, the researchers conclude.

The best time to prevent melanoma, however, is before women even reach childbearing age, Gastman said by email.

Parents should limit children's exposure to sources of ultra violet (UV) radiation that can cause skin cancer by making sure kids have sunblock or protective clothing. Parents should also educate older kids – particularly teen girls – about the melanoma risk associated with tanning beds.

"We know melanoma is rising in young women more than in young men," Gastman added. "We also know that the die may be cast (in terms of getting melanoma) during childhood. So combining all of this, this is as much a parental issue in caring for young female children as it is for young women."

SOURCE: http://bit.ly/1NkhKuP

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