Basal Cell Carcinoma and pregnancy

My wife is 39 and four months pregnant with twins. She is Eurasian and lived most of her early life in Southeast Asia where she had tremendous sun exposure.

About 7 years ago she saw a dermatologist in L.A. about two areas on her abdomen. He looked at both and only biopsied one, which turned out to be the coincidence of a wart and benign mole.

The other area, which was about a 1/2 inch area of eczema looking skin he thought nothing of and did not biopsy. Now, 7 years later, I noticed the area getting a little larger and it had started to itch so much my wife scratched it until it bled/scabbed. She went to a new dermatologist who biopsied it and it came back positive for Basal Cell Carcinoma.

Here are my questions:

1) Is is possible that it was NOT BCC 7 years ago when the first Dr. looked at it, and has only recently become cancerous?

2) The plan is to have it removed with local anesthetic in about four weeks. My wife, who is otherwise very healthy and concerned about the pregnancy, wonders if she could leave the removal until after birth, sometime in March 04. What would the risks be of doing that? One Dr. has said she could wait until March, another said it doesn't matter, and the Dermatologist made it clear he wants the thing off as soon as possible.

3) Does BCC ever become more serious or life threatening than the superficial presence she seems to have now? Presumably when they remove the whole thing it will be re-biopsied to make sure the margins are clear. Will they be looking for anything else? Are their different types of BCCs? Does depth make a difference, like it does with melanomas?

4) What are the recurrence statistics on BCC? How vigilant will she need to be after all this. (She's been out of the sun for about 10 years now, ironically.)

5) It seems to be in an odd place for BCC - around the bikini line. Aren't most BCCs in older men and on areas like the face or arms?

6) The changes occured after she became pregnant. Do hormonal changes during pregnancy exacerbate these skin cancers?

I am just generally worried. These will be our first children. My wife has never smoked, drank, or done anything harmful to her body (except childhood sun exposure) so it seems like a cruel blow to have to deal with this during pregancy.

Thanks in advance for any advice, answers, etc.

[Alan Rockoff, MD]

Please don't worry.  This is not a serious matter, and it won't affect your ability to have children.

Many basal cells occur in areas not very sun-exposed.  (There are other factors--genetics, luck, etc.)  They do not spread or turn into something else.  There are different forms of basal cell (superficial, nodular, etc.), but these have little differences among them and are not analogous to melanoma.  Your wife won't need to be more vigilant than to have an annual look-over by a dermatologist.

The surgery can be safely done during pregnancy, although since the lesion is not in a cosmetically sensitive area like the nose, I don't see any harm in waiting a few months either.  The worst it could do is grow a millimeter  (it may well have been there for years--this happens all the time with non-facial basal cells.)

Please discuss this with your dermatologist, but any way you go, she's going to be fine.

Good luck with your new baby.

Dr. Rockoff

[bmw1]

Dr. Rockoff

Thanks very much for your reassuring comments.

bwm1