Pregnancy and melanoma

January 23, 2016

Two recently published retrospective studies provide differing perspectives on the influence of pregnancy on the development, progression and prognosis of melanoma.

Abstract 1

Background
Melanoma is the fifth most common cancer in the United States, with recent reports indicating increasing incidence among young women.

Objective
This study sought to investigate histopathology, staging, risk factors, and outcomes of cutaneous melanoma in women younger than 50 years.

Methods
All female patients aged up to 49 years with biopsy-proven diagnosis of melanoma between 1988 and 2012 were included. Patients with a follow-up of less than 2 years were excluded.

Results
A total of 462 patients were identified, with mean age of 34.7 years. Invasive melanoma was less common in women 19 years of age or younger (P < .0008). Positive sentinel node status (P < .008), recurrence rates, metastatic disease (P < .001), and death rates (P < .008) were higher for women ages 40 to 49 years.

The 41 patients with a pregnancy-associated melanoma had a significantly worse prognosis in comparison with a control group of nonpregnant patients, with a 9-fold increase in recurrence (P < .001), 7-fold increase in metastasis (P = .03) and 5-fold increase in mortality (P = .06).

Limitations
This was a retrospective study.

Conclusion
The increasing incidence of melanoma for women younger than 50 years suggests that regular skin checks and self-examinations are warranted. In addition, in women given the diagnosis of melanoma during or within 1 year after childbirth, regular follow-up and monitoring for recurrence are recommended.

Source:
Tellez, A, et al. Risk factors and outcomes of cutaneous melanoma in women less than 50 years of age. JAAD. 20 January 2016. Article in Press. http://www.jaad.org/article/S0190-9622(15)02480-9/...

Abstract 2

Background
The influence of pregnancy on the development, progression, and prognosis of melanoma is controversial.

Objective
We sought to compare clinical characteristics, histologic features, and proliferative activity in pregnancy-associated melanoma (PAM) and melanoma in nonpregnant women of reproductive age (non-PAM).

Methods
In this retrospective cohort study, we reviewed medical records and pathology reports from women given a diagnosis of melanoma between 2006 and 2015. We also examined tumor proliferation rates using mitotic count and 2 immunohistochemical markers of proliferation, phosphohistone H3 and Ki-67.

Results
In 50 PAM and 122 non-PAM cases, a diagnosis of melanoma in situ was associated with PAM. Among invasive melanomas, there was no difference in proliferative activity between groups. Pregnancy status was also not associated with age at diagnosis, tumor site, Breslow depth, Clark level, ulceration, or overall stage.

Limitations
This was a retrospective study with a small sample size of mostly patients with early-stage melanoma.

Conclusions
In our study of primarily early-stage melanoma, pregnancy did not have a significant impact on tumor proliferation. Particularly for patients given a diagnosis of stage I melanoma who are undergoing close surveillance, a history of PAM should not outweigh traditional factors, such as advanced maternal age, in planning future pregnancies.

Source:

Merkel, EA. A comparative study of proliferative activity and tumor stage of pregnancy-associated melanoma (PAM) and non-PAM in gestational age women. JAAD 2016l74(1):88-93. http://www.jaad.org/article/S0190-9622(15)02201-X/...