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".)
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- 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