Melanoma in Pregnancy

Abstract

Since the early 1950s clinicians have been concerned about the impact of pregnancy on malignant melanoma (MM). Case reports and case series described a grave prognosis for women diagnosed with MM during pregnancy. Today MM in pregnancy takes on enhanced significance as more women delay childbearing into their 30s and 40s, and the incidence of MM during pregnancy may be expected to increase. In addition, relative immunosuppression during pregnancy theoretically may favor the potential for MMs to behave more aggressively. This article compiles the most recent clinical, epidemiologic, and laboratory studies to guide clinicians in addressing the issue of melanoma in pregnancy. Herein we address the prognosis, characteristics, evaluation, treatment, and how to counsel women diagnosed with MM during pregnancy, including the potential consequences for the fetus. Overall, our analysis reveals that there is no effect on survival in women diagnosed with localized MM during pregnancy; likewise, pregnancies prior or subsequent to a diagnosis of MM do not impact prognosis. Strong epidemiologic evidence shows no enhanced risk of developing MM associated with oral contraceptive pill use. Although a smaller number of studies have addressed hormonal replacement therapy and risk of MM, these studies do not suggest a higher risk of MM. As for the fetus, risk of metastasis to the placenta and/or fetus is extremely low, and seems to occur exclusively in women with widely metastatic MM.

Effect of biology on the outcome of female melanoma patients

“…Contrary to this finding, another in vitro study demonstrated that tamoxifen significantly hindered cell invasion in melanoma; in addition, it was found that, apart from melanoma, breast, esophageal, pancreatic, lung, gastric and colorectal cancers and soft tissue sarcomas exhibited the same female survival advantage (18). Neither melanoma diagnosed during pregnancy was found to affect survival rate, nor the pregnancy that occurred before or after the diagnosis of melanoma was shown to affect the survival outcome of melanoma; furthermore, oral contraceptive use and hormone replacement therapies were not found to be associated with increased risk of melanoma development and/or prognosis (19). In the present study, we were unable to assess the definitive role of sex hormones in melanoma, due to relevant information (such as menopausal status or oral contraceptive use of the study group) missing from our data, which was defined as another limitation of this study.…”

Progesterone and Melanoma Cells: An Old Story Suspended between Life and Death

“…Others larger multivariate analyses, however, demonstrated that it was equally strong in pre-as well as in post-menopausal groups [20]. Parallely, the literature concerning melanoma progression in pregnancy is also controversial [21][22][23][24], although several recent reports demonstrate that pregnancyassociated melanomas have poorer outcomes than other melanomas [25][26][27][28][29].…”

Progesterone and Melanoma Cells: An Old Story Suspended between Life and Death

“…Others larger multivariate analyses, however, demonstrated that it was equally strong in pre-as well as in post-menopausal groups [20]. Parallely, the literature concerning melanoma progression in pregnancy is also controversial [21][22][23][24], although several recent reports demonstrate that pregnancyassociated melanomas have poorer outcomes than other melanomas [25][26][27][28][29].In vitro progesterone influences melanoma growth [30][31][32][33], but several melanoma cell lines have been studied and very different experimental protocols have been used, so that the results actually available in literature are not univocal. Further research on this topic is thus needed, especially in view of the widespread use of PG in clinical practice.…”