Managing melanoma in pregnancy
Melanoma is the most common malignancy in women of reproductive age and an estimated 35% of women with melanoma are of child-bearing age. The incidence of melanoma during pregnancy in NSW was estimated at 51.8 per 100,000 maternities in 2008.
Melanoma is rare during pregnancy, and there is a paucity of evidence concerning its treatment and prognosis in pregnant patients.
Prognosis of melanoma diagnosed during pregnancy
There have been a number of studies investigating the prognosis of melanoma diagnosed in pregnancy, but they have had conflicting results. Most have been retrospective cohort or case control studies. The definition of pregnancy-associated melanoma has differed amongst studies, with some including women who were up to 5 years post-partum. Some studies did not control for risk or prognostic factors such as sun exposure and tumour thickness, and mortality was often calculated as overall mortality rather than disease-specific mortality.
Older studies did not show that melanoma during pregnancy had an adverse impact on survival. A 2014 Swedish cohort study also found no difference in melanoma-specific mortality in melanoma associated with pregnancy compared with melanoma occurring in women of childbearing age who were not pregnant. This contrasts with another nationwide cohort study from Norway which showed an increased mortality for melanoma occurring during pregnancy. In a review of nine retrospective cohort studies and two population-based studies, Byrom et al reported that pregnancy-associated melanoma had a 56% increased risk of mortality compared to melanoma in women of childbearing age who were not pregnant. Another meta-analysis of 15 studies found that pregnancy-associated melanoma had a 17% higher mortality and a 50% higher recurrence rate than melanoma not associated with pregnancy. A small retrospective study of patients with retinal melanoma found no association between pregnancy and survival.
There is conflicting evidence regarding the prognosis of melanoma occurring in pregnancy.
Topics in this section cover:
- ↑ Lee YY, Roberts CL, Dobbins T, Stavrou E, Black K, Morris J, et al. Incidence and outcomes of pregnancy-associated cancer in Australia, 1994-2008: a population-based linkage study. BJOG 2012 Dec;119(13):1572-82 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22947229.
- ↑ Bannister-Tyrrell M, Roberts CL, Hasovits C, Nippita T, Ford JB. Incidence and outcomes of pregnancy-associated melanoma in New South Wales 1994-2008. Aust N Z J Obstet Gynaecol 2015 Apr;55(2):116-22 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25349945.
- ↑ Berretta M, Di Francia R, Lleshi A, De Paoli P, Li Volti G, et al. Antiblastic treatment, for solid tumors, during pregnancy: a crucial decision. Int J Immunopathol Pharmacol 2012 Apr;25(2 Suppl):1S-19S Available from: http://www.ncbi.nlm.nih.gov/pubmed/23092516.
- ↑ Savoia P, Ortoncelli M, Osella-Abate S et al. Melanoma and pregnancy: A 30-year experience at the Turin Melanoma Centre and a review of the literature data. G Ital Dermatol Venereol 2007;142(1) Available from: https://www.minervamedica.it/en/journals/dermatologia-venereologia/article.php?cod=R23Y2007N01A0001.
- ↑ Reintgen DS, McCarty KS Jr, Vollmer R, Cox E, Seigler HF. Malignant melanoma and pregnancy. Cancer 1985 Mar 15;55(6):1340-4 Available from: http://www.ncbi.nlm.nih.gov/pubmed/3971302.
- ↑ McManamny DS, Moss AL, Pocock PV, Briggs JC. Melanoma and pregnancy: a long-term follow-up. Br J Obstet Gynaecol 1989 Dec;96(12):1419-23 Available from: http://www.ncbi.nlm.nih.gov/pubmed/2620053.
- ↑ Wong JH, Sterns EE, Kopald KH, Nizze JA, Morton DL. Prognostic significance of pregnancy in stage I melanoma. Arch Surg 1989 Oct;124(10):1227-30; discussion 1230-1 Available from: http://www.ncbi.nlm.nih.gov/pubmed/2802988.
- ↑ Slingluff CL Jr, Reintgen DS, Vollmer RT, Seigler HF. Malignant melanoma arising during pregnancy. A study of 100 patients. Ann Surg 1990 May;211(5):552-7; discussion 558-9 Available from: http://www.ncbi.nlm.nih.gov/pubmed/2339917.
- ↑ 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 Available from: http://www.ncbi.nlm.nih.gov/pubmed/1672000.
- ↑ Lens MB, Rosdahl I, Ahlbom A, Farahmand BY, Synnerstad I, Boeryd B, et al. Effect of pregnancy on survival in women with cutaneous malignant melanoma. J Clin Oncol 2004 Nov 1;22(21):4369-75 Available from: http://www.ncbi.nlm.nih.gov/pubmed/15514378.
- ↑ Silipo V, De Simone P, Mariani G, Buccini P, Ferrari A, Catricala C. Malignant melanoma and pregnancy. Melanoma Res 2006 Dec;16(6):497-500 Available from: http://www.ncbi.nlm.nih.gov/pubmed/17119450.
- ↑ Daryanani D, Plukker JT, De Hullu JA, Kuiper H, Nap RE, Hoekstra HJ. Pregnancy and early-stage melanoma. Cancer 2003 May 1;97(9):2248-53 Available from: http://www.ncbi.nlm.nih.gov/pubmed/12712479.
- ↑ Stukel TA, Demidenko E, Dykes J, Karagas MR. Two-stage methods for the analysis of pooled data. Stat Med 2001 Jul 30;20(14):2115-30 Available from: http://www.ncbi.nlm.nih.gov/pubmed/11439425.
- ↑ O'Meara AT, Cress R, Xing G, Danielsen B, Smith LH. Malignant melanoma in pregnancy. A population-based evaluation. Cancer 2005 Mar 15;103(6):1217-26 Available from: http://www.ncbi.nlm.nih.gov/pubmed/15712209.
- ↑ Houghton AN, Flannery J, Viola MV. Malignant melanoma of the skin occurring during pregnancy. Cancer 1981 Jul 15;48(2):407-10 Available from: http://www.ncbi.nlm.nih.gov/pubmed/7237410.
- ↑ Holly EA. Melanoma and pregnancy. Recent Results Cancer Res 1986;102:118-26 Available from: http://www.ncbi.nlm.nih.gov/pubmed/3738179.
- ↑ Johansson AL, Andersson TM, Plym A, Ullenhag GJ, et al. Mortality in women with pregnancy-associated malignant melanoma. J Am Acad Dermatol 2014 Dec;71(6):1093-101 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25440438.
- ↑ 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 Jan 1;27(1):45-51 Available from: http://www.ncbi.nlm.nih.gov/pubmed/19029418.
- ↑ 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 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25690106.
- ↑ 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 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28430756.
- ↑ Lemaître S, Lévy-Gabriel C, Desjardins L, Plancher C, Asselain B, Vincent-Salomon A, et al. Choroidal melanoma and pregnancy. Acta Ophthalmol 2016 Nov;94(7):e652-e660 Available from: http://www.ncbi.nlm.nih.gov/pubmed/27009598.