Pregnancy following diagnosis of melanoma

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A systematic review was performed to answer the following question: 'Does pregnancy following a diagnosis of melanoma affect prognosis?

Evidence summary and recommendations

There is little information in the literature regarding the effect of subsequent pregnancy on the prognosis of melanoma. A systematic review and meta-analysis in 2015 evaluated the effect of pregnancy following diagnosis and treatment of melanoma. There were only five eligible studies identified for inclusion in the analysis, 2 population cohort studies and 3 retrospective clinical cohort studies, with these studies suggesting that the risk of mortality from melanoma did not increase in a subsequent pregnancy.[1] Older studies have shown that pregnancy does not increase the subsequent risk of having melanoma,[2] with no increased risk of melanoma developing during subsequent pregnancy.[3] Moreover, women with higher parity have a reduced risk of melanoma.[2] There appears to be no effect of subsequent pregnancy on the prognosis of melanoma.[4][5]


Evidence summary Level References
Pregnancy-associated cutaneous melanoma may have an increased risk of mortality. III-3 [6], [7]
Pregnancy occurring following treatment of melanoma does not appear to increase the risk of recurrence. III-3 [1]

Note on recommendations based on this evidence

No direct recommendations were formulated based on this evidence because it serves to describe prognosis, not to evaluate the effects of interventions to manage prognosis.


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Regular skin examination should be performed in pregnant women so that suspicious lesions can be dealt with in a timely fashion.

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Recommendations

There are no standard guidelines for patients who wish to become pregnant after the diagnosis and treatment of melanoma. It has been recommended that women avoid pregnancy for two to five years after the diagnosis of high-risk melanoma, whether or not the melanoma occurred during pregnancy,[8] as most recurrences are diagnosed within this period. However, recurrence is not always predictable and factors such as the age of the patient and the features of the melanoma need to be taken into account when pregnancy is contemplated following treatment of melanoma.


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Women of childbearing age who are within five years of primary treatment of a high-risk melanoma should be fully informed of their prognosis when considering pregnancy.

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References

  1. 1.0 1.1 Byrom L, Olsen CM, Knight L, Khosrotehrani K, Green AC. Does pregnancy after a diagnosis of melanoma affect prognosis? Systematic review and meta-analysis. Dermatol Surg 2015 Aug;41(8):875-82 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26177116.
  2. 2.0 2.1 Karagas MR, Zens MS, Stukel TA, Swerdlow AJ, Rosso S, Osterlind A, et al. Pregnancy history and incidence of melanoma in women: a pooled analysis. Cancer Causes Control 2006 Feb;17(1):11-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16411048.
  3. Houghton AN, Balch CM. Treatment for advanced melanoma. In Balch CM,Houghton AN, Milton GW, Sober AJ, Soong SJ, editors. Cutaneous Melanoma. Philadelphia: Lippincott 1992;165–187.
  4. Reintgen DS, McCarty KS Jr, Vollmer R, Cox E, Seigler HF. Malignant melanoma and pregnancy. Cancer 1985 Mar 15;55(6):1340-4 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/3971302.
  5. MacKie RM, Bufalino R, Morabito A, Sutherland C, Cascinelli N. Lack of effect of pregnancy on outcome of melanoma. For The World Health Organisation Melanoma Programme. Lancet 1991 Mar 16;337(8742):653-5 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/1672000.
  6. Byrom L, Olsen C, Knight L, Khosrotehrani K, Green AC. Increased mortality for pregnancy-associated melanoma: systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2015 Aug;29(8):1457-66 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25690106.
  7. Kyrgidis A, Lallas A, Moscarella E, Longo C, Alfano R, Argenziano G. Does pregnancy influence melanoma prognosis? A meta-analysis. Melanoma Res 2017 Aug;27(4):289-299 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/28430756.
  8. Holly EA, Weiss NS, Liff JM. Cutaneous melanoma in relation to exogenous hormones and reproductive factors. J Natl Cancer Inst 1983 May;70(5):827-31 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/6573527.


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Appendices