Malignant melanoma in pregnancy

Abstract

BACKGROUNDFor many years, there has been controversy in the medical community regarding the correlation of female hormonal factors with the outcome of women with malignant melanoma. There have been multiple reports that women with high hormone states, such as pregnancy, had thicker tumors and/or a worse prognosis compared with a group of control women.METHODSThe authors used a database that contained maternal and neonatal discharge records from the entire state of California from 1991 to 1999 and linked those records to the California Cancer Registry, which maintains legally mandated records of all cancers reported in California during the same time period. Four hundred twelve women with malignant melanoma diagnosed during or within 1 year after pregnancy were identified (145 antepartum, 4 at delivery, and 263 postpartum) and were compared with a group of age‐matched, nonpregnant women with melanoma (controls). The database captured only pregnancies at ≥ 20 weeks of gestation.RESULTSWhen comparing women who had pregnancy‐associated melanoma with the control group, the authors found no difference in the distribution of disease stage (82.0% of pregnant and postpartum women had localized melanoma vs. 81.9% of control women) or the tumor thickness (mean: 0.77 mm for pregnant women, 0.90 mm for postpartum women, and 0.81 mm for the control group). In a multiple regression model that controlled for age, race, stage, and tumor thickness, pregnancy had no impact on survival in women with melanoma. Lymph node assessment and positivity of lymph nodes also were equivalent between the two groups. Maternal and neonatal outcomes did not differ between pregnant women with melanoma and control women who were pregnant and had no history of malignancy. Small numbers of women with advanced melanoma and the inability to capture melanoma that occurred in pregnancies that were lost or were terminated prior to 20 weeks limited the conclusions primarily to women with localized melanoma.CONCLUSIONSIn this large, population‐based study of pregnant women in California from 1991 to 1999 with malignant melanoma, there were no data found to support a more advanced stage, thicker tumors, increased metastases to lymph nodes, or a worsened survival. The outcome for women with localized melanoma associated with pregnancy was excellent. Maternal and neonatal outcomes also were equivalent to those of pregnant women without melanoma. Cancer 2005. © 2005 American Cancer Society.

Malignant melanoma and pregnancy

“…Moreover, no differences were found in the mean or median tumour thickness in the two groups. In this study, it is reported that, although there was a longer time between diagnosis and surgical removal for both pregnant and post-partum women than that for the control group, management was not altered in the number of women undergoing lymph node evaluation and no apparent clinical impact resulted with no difference in outcomes [16].…”

“…O'Meara et al [16] found that 82% of pregnant women with melanoma were diagnosed with localized disease as compared with non-pregnant control group patients. Moreover, no differences were found in the mean or median tumour thickness in the two groups.…”

Sex disparities in melanoma outcomes: The role of biology

“…Exogenous estrogens such as oral contraceptives and hormone-replacement therapy have been studied for many years for their potential to influence melanoma and although some studies supported an effect of exogenous estrogen on melanoma outcomes [21], other studies did not find this association to be significant [22][23][24][25]. Studies with smaller sample sizes found that women diagnosed with melanoma during pregnancy have increased risk of recurrence and mortality [26][27][28][29], but more recent large population based studies did not find any association between pregnancy and melanoma outcome [30][31][32].…”

Estrogen Receptor β in Melanoma: From Molecular Insights to Potential Clinical Utility

“…Melanoma neoplasms are thicker during pregnancy than those diagnosed outside of pregnancy (67), and this is in line with the observation that diethylstilbestrol enhances melanomagenesis in mouse B16 melanoma cells (68). However, it is still unclear whether melanoma patients during pregnancy have worsened outcomes with respect to non-pregnant patients (67, 69, 70). Similar contrasting results were reported on the incidence of melanoma during menopause (71).…”