Managing melanoma in pregnancy

From Clinical Guidelines Wiki


Background

Melanoma is the most common malignancy in women of reproductive age[1] 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.[2]

Melanoma is rare during pregnancy, and there is a paucity of evidence concerning its treatment and prognosis in pregnant patients.

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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.[3][4][5][6][7][8][9][10][11][12][13][14][15][16] 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.[17] This contrasts with another nationwide cohort study from Norway which showed an increased mortality for melanoma occurring during pregnancy.[18] 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.[19] 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.[20] A small retrospective study of patients with retinal melanoma found no association between pregnancy and survival.[21]

There is conflicting evidence regarding the prognosis of melanoma occurring in pregnancy.


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References

  1. 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 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22947229.
  2. 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 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25349945.
  3. 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 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23092516.
  4. 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) Abstract available at https://www.minervamedica.it/en/journals/dermatologia-venereologia/article.php?cod=R23Y2007N01A0001.
  5. 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.
  6. 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 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/2620053.
  7. 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 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/2802988.
  8. 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 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/2339917.
  9. 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.
  10. 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 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15514378.
  11. 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 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17119450.
  12. 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 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12712479.
  13. 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 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11439425.
  14. 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 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15712209.
  15. Houghton AN, Flannery J, Viola MV. Malignant melanoma of the skin occurring during pregnancy. Cancer 1981 Jul 15;48(2):407-10 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/7237410.
  16. Holly EA. Melanoma and pregnancy. Recent Results Cancer Res 1986;102:118-26 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/3738179.
  17. 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 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25440438.
  18. 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 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19029418.
  19. 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.
  20. 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.
  21. 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 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/27009598.

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