Melanoma is one of the most aggressive forms of skin cancer and rates have been rising steadily for the last two decades, putting increasing pressure on public health departments. A recent report into the shortage of dermatologists in the US has highlighted the potentially dangerous repercussions to the public, and especially to pregnant women, of not receiving adequate diagnosis and treatment for skin cancer.

The report shows that 20% of areas don’t have access to a dermatologist within a 50 mile radius, and in some cases it’s as far as 100 miles. In these areas there’s a higher number of deaths from melanoma, which is being put down to the shortage and the fact that women are unable to get a diagnosis fast enough, which can be fatal in melanoma cases.

Medicaid Are Not Providing Adequate Care

Research into melanoma treatment has indicated that those with Medicaid insurance in the US were 36% more likely to experience delays in the surgical removal of their cancer than other patients. Considering that around approximately half of pregnant women are covered by Medicaid, and that waiting longer than 6 weeks for treatment can massively increase the chance of complications, health groups are urging the government to set up funded health insurance programs to help those at risk.

Another common problem is that many doctors don’t accept Medicaid patients at all due to reduced funding. According to Melanoma oncologist at the MD Anderson Cancer Center in Houston Sapna Patel M.D “We have a real access-to-care issue. Women who call the Medicaid community health center for a derm referral might have to wait months for an appointment and then also experience a delay in treatment.”

Increased Risks During Pregnancy

Almost a third of new diagnoses of melanoma occurred in women in their twenties and thirties, which are the main childbearing years. Although cases are still uncommon, pregnant women often prioritize skin checks, which makes them much more vulnerable to complications should they be diagnosed. Pregnancy can also decrease the effectiveness of the immune system, and could trigger melanoma in some women or make it more dangerous.

Patel explained that “This is nature’s way of preventing the body from rejecting something ‘foreign’ and protecting the fetus—but we rely on that immune system to protect the body from things like cancer and melanoma. In some cases, melanomas can emerge due to what we call ‘immune escape,’” meaning they sneak through the gates while the immune system is compromised. While there’s a lot we don’t know, we see concerning patterns with melanoma being diagnosed at a more advanced state, and progressing faster in pregnancy,”

Protecting Women During Pregnancy

When melanoma spreads to other organs, it can require more complex treatment like immunotherapy, which can’t be used during pregnancy due to the increased risks. Although very rare, there are cases where melanoma can cross through the placenta to the baby from the mother. When caught early, most localized melanomas are treatable and won’t put the woman or baby at any extra risk.

Patel said “If a patient has metastatic melanoma and is in her first or second trimester, it’s unlikely she’ll be able to deliver to term without the melanoma becoming very life-threatening. It’s tragic when this happens because the baby will usually develop melanoma within the first year of life, and because the disease is advanced, it’s always fatal”

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