A heavily pregnant mother, already caring for a one-year-old daughter, could have easily ignored the small freckle on her neck.
But in late 2022, Pauline Ryan says despite being preoccupied with the upcoming arrival of her second child, she couldn’t shake the feeling that something wasn’t ‘quite right’ about it.
‘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’d first noticed the freckle appear during her pregnancy with her eldest daughter, and it quickly developed into a mole during her second pregnancy.
At 37, Pauline clocked the mole’s sudden appearance but tried to compartmentalise it into the ‘too hard right now’ basket.
However, she could no longer ignore the spot when two separate friends commented to Pauline within a matter of days that she should get it ‘looked at’.
Furthermore, it had begun intermittently bleeding when Pauline’s 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.
Melbourne woman Pauline Ryan was a new mother to her eldest daughter, Abigail, and pregnant with her second child when she noticed a new freckle-turned-mole visible on her neck
Even though she was just weeks away from giving birth to her second child, Pauline decided to visit a skin cancer clinic and have the mole checked
Pauline visited a skin cancer clinic which cost her $400 out of pocket. The first clinician she saw wasn’t 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.
Although Pauline was fortunate to have had an immediate second-opinion, she said that it’s ‘concerning’ and unfortunately common for this type of misdiagnosis to occur due to the variable standards of skin cancer clinician training.
The diagnosis came by way of 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.
Pauline’s 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.’
Only ten days after giving birth, Pauline had a wide local excision, removing about 10 centimetres around the mole
With her due date rapidly approaching, the next call was to the obstetrician.
‘When I told him he said, “Oh, bugger”. Literally his words. And then we had to figure out a plan.’
The strategy was to get Pauline into hospital in the upcoming days and induce labour. But it wasn’t necessary because upon arrival she was already in labour and the newborn was delivered – healthy and safe.
Still, the joy faded quickly. At home with new baby Neve, Pauline’s thoughts soon turned to her impending cancer surgery that was only days away.
‘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 recalled.
‘I kept crying for the first couple of days at home.
‘And then my older daughter was also only 17 months at that time, so I’m also struggling with the two not sleeping and just my own emotions.’
While it’s highly common for women to experience baby blues or extreme emotional exhaustion in the early days of motherhood, Pauline knew her mental health struggle was something else.
‘It was anxiety,’ she said. ‘Knowing that I was going to leave my daughter to go and have surgery – that was the thing that was upsetting me most.’
Only ten days after giving birth, Pauline had her first cancer treatment surgery – a wide local excision, removing about 10 centimetres around the mole, since melanoma can spread aggressively.
She hoped the scare was behind her, and threw herself into mothering her newborn.
But three months later, Pauline felt a lump near her surgery scar and dread returned. Her surgeon immediately ordered biopsies and a PET scan. The tests confirmed the melanoma had spread to her lymph node, meaning it was a metastatic melanoma.
Subsequent biopsies and a PET scan confirmed that the melanoma had spread to her lymph node, meaning it was a metastatic melanoma
Pauline, pictured here with her husband Carl, made the decision to join a clinical trial for a new immunotherapy drug, followed by surgery. This also meant she had to cease breastfeeding her baby daughter Neve during the course of the treatment
A new course of treatment was now required and Pauline opted to join a clinical trial for a new immunotherapy drug, followed by surgery.
However, this course of action had knock-on effects to her family life. For one, taking the immunotherapy drug meant any future hopes of adding to their family would need to be on hold.
It also meant that Pauline would have to stop breastfeeding and switch Neve to bottle feeding with formula, which presents a range of physical and emotional challenges.
‘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 of family and close friends for helping her and her firefighter husband throughout the treatment phase – particularly with helping to care for their young daughters.
Unexpectedly, Pauline says the challenges that come with raising two children under the age of two wound up being ‘a nice distraction’ at times when she was simultaneously undergoing treatment.
Although Pauline’s memories of this period during treatment are hazy now – something she says may have been ‘a bit of protective amnesia’ – she forged her way through it.
By the end, doctors confirmed she had had a ‘complete pathological response’ to treatment with ‘no remnants of any melanoma’.
Pauline recalled that the most mentally challenging aspect of her skin cancer battle surprisingly came after she had completed treatment and was in remission
Pauline admits to feeling ‘mum guilt’ because the first year of her youngest daughter’s life was focused on her health rather than family life
Pauline recalls that it was at this point and over the next 12 months when she was officially classified as in remission that the mental hardships of what she’d been through truly took hold.
‘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.
‘I think it’s because I had this “mum guilt”, because I thought the first year of my daughter Neve’s life would be focusing on her and being a family. But instead, it was about my health.’
Pauline is now two years in remission – but continues to undergo regular quarterly monitoring to ensure the cancer doesn’t return.
Physically, she admits to some self-consciousness about living with a large scar on her neck and sometimes deals with the discomfort of lymphedema and swelling.
‘The scar is quite big, but at the same time it’s a reminder that I’m alive,’ she said.
Ultimately, this skin cancer battle inspired Pauline to campaign for change.
‘It’s fuelled me to want to improve outcomes for others,’ she said.
‘We need generational change, because we’re really just not hitting the mark with what we’re doing, it’s not working.’
Pauline’s personal skin cancer battle inspired her to join forces with MCAS, the Melanoma and Skin Cancer Advocacy Network (MSCAN). In her role as a volunteer spokesperson, she joined them at Parliament House on November 26 to launch the National Skin Cancer Scorecard
Pauline now juggles her busy life as a wife and mother-of-two alongside her passion to spread awareness and promote big picture change in the skin cancer realm
The contract project manager switched her career area of focus to the cancer space, and she also connected with MCAS, the Melanoma and Skin Cancer Advocacy Network (MSCAN), where she now serves as their volunteer spokesperson.
On November 26, MSCAN and the Australasian College of Dermatologists (ACD) launched Australia’s first National Skin Cancer Scorecard at Parliament House.
Pauline attended the launch, which called for the sector to unite in saving lives, improving equity, and reducing the $2.47 billion annual burden of skin cancer treatment on the health system.
The Scorecard, developed by MSCAN, ACD and other stakeholders identifies gaps and calls for more focus on overlooked skin cancers and regional and younger patients.
It presents 16 items that track the progress of skin cancer prevention, early detection, treatment, and support and care in Australia to date.
Pauline is now passionate about lobbying for big-picture change on a government level to reduce skin cancer risk.
‘This is, literally, our national cancer, yet we don’t have a proper strategy,’ she said.
‘We need generational change. What we’re doing isn’t working.’
She advocates for things like reducing inequity and out-of-pocket costs for skin checks, and believes education is crucial.
‘I see so many gaps in skin cancer awareness, and I think these could be easy wins,’ she said.
‘Our attitudes need to change, and we as a nation need to prioritize skin cancer and awareness of skin cancer.’
