Advice for Evaluating Pregnant Patients in Dermatology, With Jane M. Grant-Kels, MD

A session titled ‘The Pregnant Pause: How to Evaluate and Treat Your Pregnant Patients’ was presented at the 2026 American Academy of Dermatology (AAD) Annual Meeting in Denver, Colorado.1

One of the presenters of this session was Jane M. Grant-Kels, MD, the vice chair of the Department of Dermatology and founding director of the Cutaneous Oncology Center and Melanoma Programs and a professor of dermatology, pathology, and pediatrics at the University of Connecticut Health Center.

HCPLive interviewed Grant-Kels regarding some of the most important takeaways from this session. The following Q&A interview spotlights her responses:

HCPLive: Pregnancy presents a uniquely complex set of constraints for dermatologists such as limited evidence-based data and fetal safety concerns. In your view, what are the most common mistakes or gaps you see in how dermatologists currently approach the pregnant patient, and what does this session aim to address?

Grant-Kels: My area that I'm addressing is how to deal with melanocytic nevi and how to deal with melanoma. So during pregnancy, the woman's body changes. Obviously, her breasts enlarge, her abdomen enlarges, and melanocytic nevi on those locations can enlarge as well, but generally, melanocytic nevi do not change drastically during pregnancy. My advice is, if you have a melanocytic nevus and it's changing, you should check it with the dermatoscope, and if there are any changes that suggest malignancy, the lesion should be biopsied immediately.

Having said that, there's no suggestion that patients when pregnant have a higher incidence of developing melanoma. I also address the controversy about whether melanoma when it is developed during pregnancy has a worse prognosis, and that has been assumed in the past, because when women are pregnant, they are somewhat immunosuppressed. They have induced lymphangiogenesis and other angiogenesis…The evidence shows that when a woman is pregnant and if she does develop a melanoma, her prognosis is not different than if she were not pregnant. And so you treat them the same. So that is a sum of what I have to say to the audience.

HCPLive: Is there a general lack of clinical data, clinical trial data, regarding pregnant patients in the dermatology space, and is that the kind of thing that can be addressed?

Grant-Kels: It's very hard to do studies on obstetricians don't like to share their pregnant patients for clinical trials, even if it's just observation and watching their moles. We did a study many years ago, and it took us a long time to get a significant number of pregnant women because it was very hard to induce obstetricians to refer patients, even though we were just examining their backs and their nevi on their backs. So yes, there is a paucity, and obviously clinical trials are very rarely done in pregnant women because of the fact that they're obviously they're carrying a fetus.

You wouldn't want to expose them to drugs unnecessarily, so that is an issue. And because of that, and because when a woman is pregnant and does develop a melanoma, especially if it's a high risk deep melanoma, those tend to get reported as case reports. So there are years of people under the false impression that pregnancy increased your risk of melanoma because of those case reports, when, in fact, when large studies are done looking at pregnant versus non pregnant women with control groups, there is no increased incidence of melanoma during pregnancy.

HCPLive: Among patients, are there concerns that you've seen among pregnant patients related to concerns such as these?

Grant-Kels: Patients notice that their nevi on their breasts and abdomen change. They can see the those areas, and their skin gets enlarged, so the nevi get expanded. The pregnant women also develop some hyperpigmentation. Their areola, the nipple gets darker. They can develop a linear nigra, which is a hyperpigmentation on their abdomen in a vertical area, and so patients notice that there are changes in their skin. They get stretch marks, then patients get very nervous if you're going to inject a numbing medication to remove a lesion, because they always are concerned that it might hurt their baby. But there is very good evidence that to do a biopsy in a pregnant woman is perfectly safe.

HCPLive: Are there any other major takeaways from this session that you really hope clinicians walk away with?

Grant-Kels: The big takeaway is that nevi don't change significantly physiologically during pregnancy. So if you have a nevus, if you have a patient who happens to be pregnant, and they're one of their nevi is changing. If you look at it with your dermatoscope and you see any features that suggest potential melanoma, you shouldn't assume those changes are physiologic. You should biopsy that patient, because just because they're pregnant doesn't mean they have an increased incidence of melanoma.

But it also doesn't mean they cannot get a melanoma because they can. There's an increased incidence of melanoma in women of childbearing age in general, that's unrelated to pregnancy, so the two can occur together. In the past, there was delay in diagnosis because many people felt that nevi changed physiologically during pregnancy. I would never make that assumption. If a nevus is changing and any features of malignancy are noted, take that lesion off. The other thing is, if you have a pregnant woman and she does develop a melanoma, you should educate her to the fact that her prognosis is not altered by her pregnancy. And especially if she has a relatively thin melanoma, she's going to do fine and it's not going to hurt her fetus.

The quotes contained in this summary were edited for clarity.

References

1. Grant-Kels J, et al. F001 The Pregnant Pause: How to Evaluate and Treat Your Pregnant Patients. Sesson presented at: 2026 American Academy of Dermatology Annual Meeting; March 27–31, 2026; Denver, CO.