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:
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- 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.
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