Melanoma and pregnancy
- Marcia S Driscoll, MD, PharmD
Marcia S Driscoll, MD, PharmD
- Clinical Associate Professor of Dermatology
- University of Maryland School of Medicine
- Jennifer A Stein, MD, PhD
Jennifer A Stein, MD, PhD
- Associate Professor of Dermatology
- NYU School of Medicine
- Jane M Grant-Kels, MD
Jane M Grant-Kels, MD
- Founding Chair, Emeritus, Department of Dermatology
- Vice Chair, Department of Dermatology
- Professor of Dermatology, Pathology, and Pediatrics
- Founding Director, Cutaneous Oncology Center and Melanoma Program
- University of Connecticut Health Center
- Section Editors
- Michael B Atkins, MD
Michael B Atkins, MD
- Section Editor — Malignant Melanoma and Other Cutaneous Neoplasms; Cancer of the Kidney
- Deputy Director
- Georgetown Lombardi Comprehensive Cancer Center
- Hensin Tsao, MD, PhD
Hensin Tsao, MD, PhD
- Section Editor — Melanocytic Lesions and Disorders of Pigmentation
- Professor of Dermatology
- Harvard Medical School
Approximately one-third of women diagnosed with melanoma are of childbearing age , and a 2015 Swedish population-based cancer registry study found that melanoma was the most common malignancy in pregnancy .
There is continuing controversy concerning the prognosis of women diagnosed with melanoma during pregnancy. Initial concerns about pregnancy's impact on prognosis in women diagnosed with melanoma date back to case reports from the 1950s. These reports suggested that pregnancy might lead to transformation of nevi into melanomas, increase the growth rate of existing melanomas, and cause localized melanomas to metastasize [3,4]. Subsequently, multiple observations seemed to support the argument that melanoma is a hormonally responsive malignancy: changes in skin pigmentation during pregnancy, detection of hormone receptors on some melanomas using older technology, a higher incidence of melanoma after puberty, and relative immunosuppression during pregnancy [5-8].
The management of women diagnosed with melanoma during pregnancy is likewise controversial, particularly concerning sentinel lymph node biopsy (SLNB) and decisions about the management of the patient with nodal or metastatic disease .
In this topic, we will review the data that address prognosis for those diagnosed with melanoma before, during, and after pregnancy. In addition, this topic will address management, including initial biopsy of suspected melanoma, wide local excision, SLNB, and decision-making concerning the use of subsequent hormonal therapy and future pregnancy.
The general approach to cutaneous melanoma is discussed separately. (See "Initial surgical management of melanoma of the skin and unusual sites".)
- Lens M, Bataille V. Melanoma in relation to reproductive and hormonal factors in women: current review on controversial issues. Cancer Causes Control 2008; 19:437.
- Andersson TM, Johansson AL, Fredriksson I, Lambe M. Cancer during pregnancy and the postpartum period: A population-based study. Cancer 2015; 121:2072.
- PACK GT, SCHARNAGEL IM. The prognosis for malignant melanoma in the pregnant woman. Cancer 1951; 4:324.
- BYRD BF Jr, McGANITY WJ. The effect of pregnancy on the clinical course of malignant melanoma. South Med J 1954; 47:196.
- Neifeld JP, Lippman ME. Steroid hormone receptors and melanoma. J Invest Dermatol 1980; 74:379.
- Grill HJ, Benes P, Manz B, et al. Steroid hormone receptor analysis in human melanoma and non-malignant human skin. Br J Dermatol 1982; 107 Suppl 23:64.
- Mitkov M, Joseph R, Copland J 3rd. Steroid hormone influence on melanomagenesis. Mol Cell Endocrinol 2015; 417:94.
- Holtan SG, Creedon DJ, Haluska P, Markovic SN. Cancer and pregnancy: parallels in growth, invasion, and immune modulation and implications for cancer therapeutic agents. Mayo Clin Proc 2009; 84:985.
- Ribero S, Longo C, Dika E, et al. Pregnancy and melanoma: a European-wide survey to assess current management and a critical literature overview. J Eur Acad Dermatol Venereol 2016.
- Johansson AL, Andersson TM, Plym A, et al. Mortality in women with pregnancy-associated malignant melanoma. J Am Acad Dermatol 2014; 71:1093.
- Reintgen DS, McCarty KS Jr, Vollmer R, et al. Malignant melanoma and pregnancy. Cancer 1985; 55:1340.
- Slingluff CL Jr, Reintgen DS, Vollmer RT, Seigler HF. Malignant melanoma arising during pregnancy. A study of 100 patients. Ann Surg 1990; 211:552.
- McManamny DS, Moss AL, Pocock PV, Briggs JC. Melanoma and pregnancy: a long-term follow-up. Br J Obstet Gynaecol 1989; 96:1419.
- Wong JH, Sterns EE, Kopald KH, et al. Prognostic significance of pregnancy in stage I melanoma. Arch Surg 1989; 124:1227.
- MacKie RM, Bufalino R, Morabito A, et al. Lack of effect of pregnancy on outcome of melanoma. For The World Health Organisation Melanoma Programme. Lancet 1991; 337:653.
- Daryanani D, Plukker JT, De Hullu JA, et al. Pregnancy and early-stage melanoma. Cancer 2003; 97:2248.
- Tellez A, Rueda S, Conic RZ, et al. Risk factors and outcomes of cutaneous melanoma in women less than 50 years of age. J Am Acad Dermatol 2016; 74:731.
- Lens MB, Rosdahl I, Ahlbom A, et al. Effect of pregnancy on survival in women with cutaneous malignant melanoma. J Clin Oncol 2004; 22:4369.
- Lens M, Rosdahl I, Newton-Bishop J. Cutaneous melanoma during pregnancy: is the controversy over? J Clin Oncol 2009; 27:e11.
- O'Meara AT, Cress R, Xing G, et al. Malignant melanoma in pregnancy. A population-based evaluation. Cancer 2005; 103:1217.
- Stensheim H, Møller B, van Dijk T, Fosså SD. Cause-specific survival for women diagnosed with cancer during pregnancy or lactation: a registry-based cohort study. J Clin Oncol 2009; 27:45.
- Møller H, Purushotham A, Linklater KM, et al. Recent childbirth is an adverse prognostic factor in breast cancer and melanoma, but not in Hodgkin lymphoma. Eur J Cancer 2013; 49:3686.
- Kouba DJ, LoPiccolo MC, Alam M, et al. Guidelines for the use of local anesthesia in office-based dermatologic surgery. J Am Acad Dermatol 2016; 74:1201.
- Murase JE, Heller MM, Butler DC. Safety of dermatologic medications in pregnancy and lactation: Part I. Pregnancy. J Am Acad Dermatol 2014; 70:401.e1.
- Crisan D, Treiber N, Kull T, et al. Surgical treatment of melanoma in pregnancy: a practical guideline. J Dtsch Dermatol Ges 2016; 14:585.
- Schwartz JL, Mozurkewich EL, Johnson TM. Current management of patients with melanoma who are pregnant, want to get pregnant, or do not want to get pregnant. Cancer 2003; 97:2130.
- Peccatori FA, Azim HA Jr, Orecchia R, et al. Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24 Suppl 6:vi160.
- Andtbacka RH, Donaldson MR, Bowles TL, et al. Sentinel lymph node biopsy for melanoma in pregnant women. Ann Surg Oncol 2013; 20:689.
- Mondi MM, Cuenca RE, Ollila DW, et al. Sentinel lymph node biopsy during pregnancy: initial clinical experience. Ann Surg Oncol 2007; 14:218.
- Oude Ophuis CM, Verhoef C, Rutkowski P, et al. The interval between primary melanoma excision and sentinel node biopsy is not associated with survival in sentinel node positive patients - An EORTC Melanoma Group study. Eur J Surg Oncol 2016.
- Broer N, Buonocore S, Goldberg C, et al. A proposal for the timing of management of patients with melanoma presenting during pregnancy. J Surg Oncol 2012; 106:36.
- Serrano-Ortega S, Buendía-Eisman A. [Melanoma and pregnancy]. Actas Dermosifiliogr 2011; 102:647.
- American College of Obstetricians and Gynecologists' Committee on Obstetric Practice. Committee Opinion No. 656: Guidelines for Diagnostic Imaging During Pregnancy and Lactation. Obstet Gynecol 2016; 127:e75.
- Travers RL, Sober AJ, Berwick M, et al. Increased thickness of pregnancy-associated melanoma. Br J Dermatol 1995; 132:876.
- Bannister-Tyrrell M, Roberts CL, Hasovits C, et al. Incidence and outcomes of pregnancy-associated melanoma in New South Wales 1994-2008. Aust N Z J Obstet Gynaecol 2015; 55:116.
- Fábián M, Tóth V, Somlai B, et al. Retrospective Analysis of Clinicopathological Characteristics of Pregnancy Associated Melanoma. Pathol Oncol Res 2015; 21:1265.
- Baergen RN, Johnson D, Moore T, Benirschke K. Maternal melanoma metastatic to the placenta: a case report and review of the literature. Arch Pathol Lab Med 1997; 121:508.
- Alexander A, Samlowski WE, Grossman D, et al. Metastatic melanoma in pregnancy: risk of transplacental metastases in the infant. J Clin Oncol 2003; 21:2179.
- Driscoll MS, Grant-Kels JM. Hormones, nevi, and melanoma: an approach to the patient. J Am Acad Dermatol 2007; 57:919.
- Gupta A, Driscoll MS. Do hormones influence melanoma? Facts and controversies. Clin Dermatol 2010; 28:287.
- Karagas MR, Stukel TA, Dykes J, et al. A pooled analysis of 10 case-control studies of melanoma and oral contraceptive use. Br J Cancer 2002; 86:1085.
- Tang JY, Spaunhurst KM, Chlebowski RT, et al. Menopausal hormone therapy and risks of melanoma and nonmelanoma skin cancers: women's health initiative randomized trials. J Natl Cancer Inst 2011; 103:1469.
- PROGNOSIS OF PREGNANCY-ASSOCIATED MELANOMA
- Study limitations
- Diagnosis during pregnancy
- Diagnosis postpartum
- Diagnosis prior to pregnancy
- MANAGEMENT OF MELANOMA DURING PREGNANCY
- Initial biopsy
- Wide local excision
- Sentinel lymph node biopsy
- Imaging studies
- - Maternal tumor
- - Placenta/fetus
- - Future pregnancies
- - Oral contraceptives
- - Hormonal replacement therapy