Pregnancy and early‐stage melanoma

Abstract

BACKGROUND Cutaneous melanomas are aggressive tumors with an unpredictable biologic behavior. It has been suggested that women who present with melanoma during pregnancy have a worse prognosis due to more aggressive behavior of the melanoma. The objective of the current study was to evaluate the long‐term effect of pregnancy on disease progression in women with Stage I–II melanoma. METHODS From 1965 to 2001, 46 pregnant women were treated for a Stage I–II melanoma at the University Medical Center Groningen. These patients were compared with an age‐matched and gender‐matched control group (nonpregnant) of 368 women with Stage I–II melanoma. The patients were staged according to the 2002 American Joint Committee on Cancer TNM classification system for melanoma. The 10‐year disease‐free survival (DFS) and 10‐year overall survival (OS) rates were calculated using logistic regression analysis. RESULTS The median age of patients in the pregnant group was 30 years (range, 18–46 years), and the median age of patients in the nonpregnant group was 36 years (range, 17–45 years). The median follow‐up was 109 months (range, 1–356 months). Pregnant patients presented more often with thicker melanomas (median, 2.0 mm vs. 1.7 mm; not statistically significant). No differences with regard to tumor location, histologic subtype, tumor ulceration, or vascular invasion were detected between the pregnant group and the nonpregnant group. There was no statistical difference in the 10‐year DFS and 10‐year OS rates between the two groups. The 10‐year DFS rates for patients in the pregnant and nonpregnant groups, respectively, were 88% versus 86% for patients with Stage I melanoma and 67% versus 73% for patients with Stage II melanoma. The 10‐year OS rates for patients in the pregnant and nonpregnant groups, respectively, were 94% versus 90% for patients with Stage I melanoma and 82% versus 81% for patients with Stage II melanoma. CONCLUSIONS Pregnancy does not appear to have an adverse, long‐term effect on survival in patients with clinically localized melanoma. Further studies should address whether pregnant patients present with thicker lesions and/or whether they have decreased DFS compared with nonpregnant women. The prognosis for women with melanoma during pregnancy, as it relates to survival, still is dependent on tumor thickness and ulceration. Cancer 2003;97:2248–53. © 2003 American Cancer Society. DOI 10.1002/cncr.11321

Melanoma During Pregnancy

“…In the study of Slingluff et al (Slingluff et al, 1990) there was no difference in the survival time, but pregnant patients were presented with a larger number of involved lymph nodes (39% versus 26%, p=0.053) at diagnosis, lymph node metastases appeared in shorter interval after the diagnosis of stage I disease (p=0.021), and shorter disease free survival (DFS). The results of following studies have not reported difference in survival among pregnant patients (MacKie et al, 1991;Stein et al, 1990;Driscoll et al, 1993;Travers et al, 1995;Grin et al, 1996;Daryanani et al, 2003), but in some a caution has been stressed to the diagnosis of thicker melanoma in pregnancy (MacKie et al, 1991;Travers et al, 1995). In already mentioned Lens et al study (Lens et al, 2004) (Figure 2.…”

Malignant melanoma arising in an in vitro fertilisation pregnancy: A case report

“…No difference was found in the 10-year disease-free and overall survival rates between the pregnant and non-pregnant groups. Survival depends on tumour thickness and the presence of ulceration (8). Previous pregnancy can exert some favourable influence on prognosis; women with at least one pregnancy had a 94% probability of surviving melanoma compared to nulliparous women, of whom only 83% survived (9).…”

State of the science 60th anniversary review

“…33 More recently, a study from Germany highlighted that pregnancy did not appear to have an adverse long-term effect on survival in patients with clinically localized melanoma. 34 Currently, there is broad agreement that prognosis for women with melanoma during pregnancy, just as for nonpregnant women and for men, is primarily dependent on tumor thickness and ulceration.…”