Malignant melanoma of the skin occurring during pregnancy

Abstract

The clinical course of melanoma of the skin diagnosed during pregnancy was compared with a control population of women with melanoma that occurred during the childbearing years, as recorded by the Connecticut Tumor Registry. The survival at three and five years for the 12 patients whose melanoma developed during pregnancy was significantly worse than for 175 nonpregnant controls (five-year survival 55% for pregnant women compared with 83% for nonpregnant women, P less than 0.05). Melanoma during pregnancy tended to occur more often on the trunk, a prognostically poor site, and at more advanced stage of disease than in nonpregnant women. However, when pregnant patients were matched to random, nonpregnant case-controls by age, anatomic site of primary lesion, and stage at diagnosis, three- and five-year survivals were not different. The number of pregnant women observed among this group of women was not substantially higher than expected, when estimated from Connecticut live birth rates: 13.3 pregnancies were expected and 12 pregnant women were actually observed. However, an unknown number of pregnancies end in abortion, making more exact estimates impossible. Melanoma occurring during pregnancy usually carries a poor prognosis, but once the disease is diagnosed, the course is not worse than expected considering stage of disease and primary site.

Melanoma During Pregnancy

“…Perhaps, diagnosis of melanoma is more frequent because patients visits the physicians more regular. According to the Connecticut Tumor Registry, the percent of melanoma that are diagnosed among pregnant women equals the one among the general female population (Houghton et al,1981). In addition, the percent of melanoma arisen by the transformation of existing nevus is from 62% to 68% in pregnant women (Houghton et al,1981;Colboum et al, 1989), which is similar to 65% found among general female population (George et al, 1960;Friedman et al, 1985).…”

“…However, because the conclusions of these studies are inconsistent, it is still unclear whether pregnancy has impact to rapid tumor growth, more rapid occurrence of metastases, and poorer survival of patients (Sampson et al, 1998;Karagas et al, 2002). From the first report on this issue, which was published in 1951 (Pack & Scharnagel , 1983), up to the '80s of the last century almost all studies demonstrate poorer surviva l r a t e f r o m m e l a n o m a d i a g n o s e d u r i n g pregnancy (Pack et al, 1951;Sutherland et al, 1983;Trapeznikov et al, 1987;Reintgen et al, 1085;McManamny et al, 1989;Wong et al, 1989;Slingluff et al, 1990;MacKie et al, 1991;O'Meara et al, 2005;Katsambas et al, 1996;Lazovich et al, 2010;Osterlind et al, 1988;Smith MA et al, 1998;Shiu et al, 1976;Houghton et al, 1981). These findings were mostly the consequence of diagnosing tumors in their higher stages during the pregnancy than in case of tumor diagnosis in nonpregnant women of the same age (Shiu et al, 1976;Houghton et al, 1981;Landthaler & Braun-Falco, 1985), and frequent appearance of trunk melanoma (Houghton et al, 1981).…”

State of the science 60th anniversary review

“…[29][30][31] In 1 population-based cancer registry of melanoma in pregnancy, the data suggested that melanoma during pregnancy carried a poor prognosis, although once the diagnosis was made, the course was not worse than expected for the stage. 32 Another study suggested that having a subsequent pregnancy had no effects on recurrence rate or survival. 33 More recently, a study from Germany highlighted that pregnancy did not appear to have an adverse long-term effect on survival in patients with clinically localized melanoma.…”

The influence of pregnancy, parity, and sex on melanoma prognosis

“…Due to their small sample sizes and lack of control for disease stage they only provided anecdotal evidence. These findings were not supported after adjustment for disease stage and known major prognostic factors such as tumour thickness (20,26,31,32).…”

“…The controversy began with a succession of case reports and case series that suggested a poorer prognosis for melanomas occurring during pregnancy with decreased survival rates (23)(24)(25)(26)(27)(28) and shorter disease-free intervals (29,30). Due to their small sample sizes and lack of control for disease stage they only provided anecdotal evidence.…”