A heavily pregnant mother, busy caring for her one-year-old daughter, could have dismissed the small freckle on her neck. But in late 2022, Pauline Ryan felt a persistent unease that something was not right with the mark.
'I was in the joys of dealing with a toddler and expecting a new baby in a few weeks - and all the usual happiness that comes with a young family,' Pauline told the Daily Mail. She had first noticed the freckle appear during her first pregnancy, and it developed into a mole during her second.
At 37, Pauline noted the mole's sudden appearance but tried to put it in the 'too hard right now' basket. However, she could no longer ignore it when two separate friends commented within days that she should get it checked. The spot had also begun bleeding intermittently when her toddler, Abigail, picked at it.
'I just told my husband one night that I had this sense of doom [about the mole] and had to do something,' she recalled.
A Fateful Check-Up and Shocking Diagnosis
Even though she was just weeks away from giving birth to her second child, Pauline decided to visit a skin cancer clinic, a visit that cost her $400 out of pocket. The first clinician she saw was not overly concerned and suggested simply removing the mole.
However, the fact Pauline was pregnant placed a tiny seed of doubt in the clinician’s mind; they called in a second opinion from a colleague who instantly raised the alarm that it could be something sinister.
Pauline noted that it is 'concerning' and unfortunately common for this type of misdiagnosis to occur due to variable standards in skin cancer clinician training.
The diagnosis came via a phone call late on a Friday afternoon: it was melanoma.
'I burst into tears. My daughter kept asking, "Why is mummy crying?". Luckily my sister was also there and we weren't alone,' she said. Her husband Carl arrived from work soon afterwards to find her distraught.
'I remember having quite a visceral response, because I was holding my toddler against my pregnant belly when I got the phone call,' she recalled. 'It was just a lot to process when you're just focusing on a birth and a toddler.'
Treatment, Trauma, and Recovery
With her due date rapidly approaching, the next call was to her obstetrician. The plan was to induce labour, but upon arrival at hospital, she was already in labour and delivered a healthy newborn, Neve.
The joy was short-lived. At home with her new baby, Pauline's thoughts turned to her impending cancer surgery, scheduled for just days later.
'I remember my neighbours came over all excited and were dropping off food, And I had just finished breastfeeding and I was sitting in a chair in the front room basically just crying,' she said. 'I kept crying for the first couple of days at home.'
Only ten days after giving birth, Pauline underwent a wide local excision, removing about 10 centimetres around the mole.
She hoped the scare was over, but three months later, she felt a lump near her surgery scar. Tests confirmed the melanoma had spread to her lymph node, meaning it was a metastatic melanoma.
A new course of treatment was required, and Pauline opted to join a clinical trial for a new immunotherapy drug, followed by surgery. This decision meant she had to cease breastfeeding her baby daughter Neve and switch to formula.
'It's not that I felt strongly about breastfeeding, but having that decision to stop breastfeeding be taken away from me was something I really struggled with,' she explained.
Pauline credits her extensive support network for helping her and her firefighter husband throughout the treatment. She also found that the challenges of raising two children under two provided 'a nice distraction' during her treatment.
By the end, doctors confirmed she had a 'complete pathological response' to treatment with 'no remnants of any melanoma'.
The Mental Health Battle and a New Mission
Surprisingly, Pauline recalled that the most mentally challenging aspect came after she had completed treatment and was in remission.
'After that remission conversation, [that's] when it all hit me, probably because I started to really process the trauma of it,' she said. 'I struggled from a mental health perspective more in that first 12 months after finishing treatment than I did while I was going through it.'
She admitted to feeling 'mum guilt', believing the first year of her youngest daughter's life should have been about family, not her health.
Pauline is now two years in remission but undergoes regular quarterly monitoring. Physically, she lives with a large scar on her neck and sometimes deals with lymphedema.
'The scar is quite big, but at the same time it's a reminder that I'm alive,' she said.
Ultimately, her battle inspired her to campaign for change. 'It's fuelled me to want to improve outcomes for others,' she stated.
She joined forces with the Melanoma and Skin Cancer Advocacy Network (MSCAN) as a volunteer spokesperson. On November 26, she attended the launch of Australia's first National Skin Cancer Scorecard at Parliament House, which calls for a united sector to save lives and reduce the $2.47 billion annual burden of skin cancer.
Pauline is now passionate about lobbying for government-level change. 'This is, literally, our national cancer, yet we don't have a proper strategy,' she argued. 'We need generational change. What we're doing isn't working.'
She advocates for reducing inequity in skin checks and believes education is crucial for improving early detection rates across the population.
