Why many pregnant women aren't screened for deadly skin cancers

One in five areas of the country don’t have a single dermatologist within 50 or even 100 miles, and in these areas—which we dubbed “derm deserts”—there are more melanoma deaths. The shortage makes it impossible for nearby women to get a timely diagnosis, and when you have melanoma—the most aggressive form of skin cancer—waiting a few months, or even weeks, for an appointment can be fatal.

Now, we’re getting hit with more bad news: Pregnant women may be particularly vulnerable.

A new study published in the journal JAMA Dermatology looked at more than 7,600 North Carolina residents who had been diagnosed with melanoma. Researchers found that those with Medicaid insurance—which covers around half of all pregnant women in the U.S., or 2 million pregnancies per year—were 36 percent more likely than those on other insurance plans to experience a delay of more than six weeks for the surgical removal of their cancer.

Yet research shows that patients should be treated within two weeks for the best chance of survival. Six weeks is the recommended maximum wait time; once melanoma has spread, it’s much harder to treat. And pregnant woman with melanoma may be at greater risk for complications from the disease than nonexpecting women­.

(Though the study was done only in North Carolina, researchers say this data can be extrapolated to the entire country—where things might be more problematic: According to our investigation, North Carolina is far from the worst of the derm-desert states; in contrast, the entire state of Utah is a desert.)

WHAT’S HAPPENING WITH MEDICAID

The government-funded health insurance program is set up to help low-income people and families, pregnant women, and those with disabilities. Many states offer Medicaid to pregnant women with higher incomes than nonpregnant women (even incomes that hover around the national average for young women) because they’re considered a “needy” group by the U.S. government. So if they’re covered, why can’t they get their melanomas removed?

Experts suggest two troubling theories:

Many doctors aren’t taking Medicaid patients.

“We have a real access-to-care issue,” said Sapna Patel, M.D., a melanoma oncologist at the MD Anderson Cancer Center in Houston. “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.”

One study found that only 32 percent of U.S. dermatologists accept new Medicaid patients. This may be because Medicaid reimburses doctors only a fraction of what private insurers do and takes longer to process those payments, studies show. Women’s Health contacted Medicaid for comment, but there was no response as of press time.

Pregnant women on Medicaid have to jump through medical hoops. The JAMA researchers surmise that Medicaid patients could be waiting longer for surgery because of poor coordination of care.