Skip to main content

Melanoma in Pregnancy

  • Chapter
  • First Online:
Melanoma in Clinical Practice

Abstract

Malignant melanoma is the most common malignancy during pregnancy. The impact of physiologic changes during pregnancy on melanoma is controversial. The literature to-date does not support a poorer prognosis for pregnancy-associated malignant melanomas. Evaluation and management of patients with pregnancy-associated malignant melanoma is similar to the nonpregnant patient, though advanced cases require special considerations for treatment and a multidisciplinary approach.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Andersson TM, Johansson AL, Fredriksson I, Lambe M. Cancer during pregnancy and the postpartum period: a population-based study. Cancer. 2015;121(12):2072–7.

    Article  PubMed  Google Scholar 

  2. Stensheim H, Moller B, van Dijk T, Fossa SD. Cause-specific survival for women diagnosed with cancer during pregnancy or lactation: a registry-based cohort study. J Clin Oncol. 2009;27(1):45–51.

    Article  PubMed  Google Scholar 

  3. 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;119(13):1572–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Lens M, Bataille V. Melanoma in relation to reproductive and hormonal factors in women: current review on controversial issues. Cancer Causes Control. 2008;19:437–42.

    Article  PubMed  Google Scholar 

  5. Jones MS, Lee J, Stern SL, Faries MBI. Pregnancy-associated melanoma associated with adverse outcomes? J Am Coll Surg. 2017;225(1):149–58.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Purdue MP, Freeman LE, Anderson WF, Tucker MA. Recent trends in incidence of cutaneous melanoma among US Caucasian young adults. J Invest Dermatol. 2008;128(12):2905–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. 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;55(2):116–22.

    Article  PubMed  Google Scholar 

  8. Pack GT, Scharnagel IM. The prognosis for malignant melanoma in the pregnant woman. Cancer. 1951;4:324–34.

    Article  CAS  PubMed  Google Scholar 

  9. Conybeare RC. Malignant melanoma in pregnancy: report of three cases. Obstet Gynecol. 1964;24:451–4.

    Article  CAS  PubMed  Google Scholar 

  10. Riberti C, Marola G, Bertani A. Malignant melanoma: the adverse effect of pregnancy. Br J Plastic Surg. 1981;34:338–9.

    Article  CAS  Google Scholar 

  11. Pennington DG. Multiple primary melanoma in pregnancy: a case report. Br J Plastic Surg. 1983;36:260–1.

    Article  CAS  Google Scholar 

  12. Byrd BF Jr, McGanity WJ. The effect of pregnancy on the clinical course of malignant melanoma. South Med J. 1954;47:196–200.

    Article  PubMed  Google Scholar 

  13. Hersey P, Morgan G, Stone DE, et al. Previous pregnancy as a protective factor against death from melanoma. Lancet. 1977;1:451–2.

    Article  CAS  PubMed  Google Scholar 

  14. Bork K, Brauninger W. Prior pregnancy and melanoma survival. Arch Dermatol. 1986;122:1097.

    Article  CAS  PubMed  Google Scholar 

  15. Lederman JS, Sober AJ. Effect of prior pregnancy on melanoma survival. Arch Dermatol. 1985;121:716.

    Article  CAS  PubMed  Google Scholar 

  16. Slinguff CL Jr, Reintgen DS, Vollmer RT, et al. Malignant melanoma arising during pregnancy: a study of 100 patients. Ann Surg. 1990;211:552–9.

    Article  Google Scholar 

  17. MacKie RM, Bufalino R, Morabito A, et al. Lack of effect of pregnancy on outcome of melanoma. Lancet. 1991;337:653–5.

    Article  CAS  PubMed  Google Scholar 

  18. Driscoll MS, Grin-Jorgensen CM, Grant-Kels JM. Does pregnancy influence the prognosis of malignant melanoma? J Am Acad Dermatol. 1993;29(4):619–30.

    Article  CAS  PubMed  Google Scholar 

  19. Driscoll MS, Martires K, Bieber AK, Pomeranz MK, Grant-Kels JM, Stein JA. Pregnancy and melanoma. J Am Acad Dermatol. 2016;75(4):669–78.

    Article  PubMed  Google Scholar 

  20. Byrom L, Olsen C, Knight L, et al. Increased mortality for pregnancy-associated melanoma: systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2015;29:1457–66.

    Article  CAS  PubMed  Google Scholar 

  21. Johansson ALV, Andersson TM, Plym A, et al. Mortality in women with pregnancy-associated melanoma. J Am Acad Dermatol. 2014;71:1093–101.

    Article  PubMed  Google Scholar 

  22. Holtan SG, Creedon DJ, Haluska P, Markovic SN. Cancer and pregnancy: parallels in growth, invasion, and immune modulation and implications for cancer therapeutic agents. Mayo Clin Proc. 2009;84:985–1000.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Betz AG. Tolerating pregnancy. Nature. 2012;490:47–8.

    Article  CAS  PubMed  Google Scholar 

  24. Nevala WK, Vachon CM, Leontovich AA, et al. Evidence of systemic Th2-driven chronic inflammation in patients with metastatic melanoma. Clin Canc Res. 2009;15:1931–9.

    Article  CAS  Google Scholar 

  25. Cristiani CM, Palella E, Sottile R, Tallerico R, Garofalo C, Carbone E. Human NK cell subsets in pregnancy and disease: toward a new biological complexity. Front Immunol. 2016;7:656.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Jacobs JFM, Nierkens S, Figdor CG, de Vries IJM, Adema GJ. Regulatory T cells in melanoma: the final hurdle towards effective immunotherapy? Lancet Oncol. 2012;13(1):32–42.

    Article  Google Scholar 

  27. Baumgartner JM, Gonzalez R, Lewis KD, Robinson WA, Richter DA, Palmer BE, et al. Increased survival from stage IV melanoma associated with fewer regulatory T cells. J Surg Res. 2009;154(1):13–20.

    Article  CAS  PubMed  Google Scholar 

  28. Chan MP, Chan MM, Tahan SR. Melanocytic nevi in pregnancy: histologic features and Ki-67 proliferation index. J Cutan Pathol. 2010;37(8):843–51.

    Article  PubMed  Google Scholar 

  29. Merkel EA, Martini MC, Amin SM, Yelamos O, Lee CY, Sholl LM, et al. A comparative study of proliferative activity and tumor stage of pregnancy-associated melanoma (PAM) and non-PAM in gestational age women. J Am Acad Dermatol. 2016;74(1):88–93.

    Article  PubMed  Google Scholar 

  30. Fabian M, Toth V, Somlai B, Harsing J, Kuroli E, Rencz F, et al. Retrospective analysis of clinicopathological characteristics of pregnancy associated melanoma. Pathol Oncol Res. 2015;21(4):1265–71.

    Article  PubMed  Google Scholar 

  31. Vihinen P, Vainio-Kaila M, Talve L, Koskivuo I, Syrjanen K, Pyrhonen S. Previous pregnancy is a favourable prognostic factor in women with localised cutaneous melanoma. Acta Oncol. 2012;51(5):662–8.

    Article  PubMed  Google Scholar 

  32. Kaae J, Andersen A, Boyd HA, Wohlfahrt J, Melbye M. Reproductive history and cutaneous malignant melanoma: a comparison between women and men. Am J Epidemiol. 2007;165(11):1265–70.

    Article  PubMed  Google Scholar 

  33. Gupta A, Driscoll MS. Do hormones influence melanoma? Facts and controversies. Clin Dermatol. 2010;28(3):287–92.

    Article  PubMed  Google Scholar 

  34. Todd SP, Driscoll MS. Prognosis for women diagnosed with melanoma during, before, or after pregnancy: weighing the evidence. Int J Women’s Dermatol. 2017;3(1):26–9.

    Article  Google Scholar 

  35. Beguerie JR, Xingzhong J, Valdez RP. Tamoxifen vs. non-tamoxifen treatment for advanced melanoma: a meta-analysis. Int J Dermatol. 2010;49(10):1194–202.

    Article  CAS  PubMed  Google Scholar 

  36. de Giorgi V, Mavilia C, Massi D, Gozzini A, Aragona P, Tanini A, et al. Estrogen receptor expression in cutaneous melanoma: a real-time reverse transcriptase-polymerase chain reaction and immunohistochemical study. Arch Dermatol. 2009 Jan;145(1):30–6.

    Article  PubMed  Google Scholar 

  37. Schmidt AN, Nanney LB, Boyd AS, King LEJ, Ellis DL. Oestrogen receptor-beta expression in melanocytic lesions. Exp Dermatol. 2006 Dec;15(12):971–80.

    Article  CAS  PubMed  Google Scholar 

  38. Fabian M, Rencz F, Krenacs T, Brodszky V, Harsing J, Nemeth K, et al. Expression of G protein-coupled estrogen receptor, GPER in melanoma and in pregnancy-associated melanoma. J Eur Acad Dermatol Venereol. 2017;31(9):1453–61.

    Article  CAS  PubMed  Google Scholar 

  39. Rodero MP, Prignon A, Avril MF, Boitier F, Aractingi S, Khosrotehrani K. Increased lymphangiogenesis in melanoma during pregnancy: correlation with the prolactin signaling pathway. J Eur Acad Dermatol Venereol. 2013;27(1):e144–5.

    Article  CAS  PubMed  Google Scholar 

  40. Massi D, Puig S, Franchi A, Malvehy J, Vidal-Sicart S, Gonzalez-Cao M, et al. Tumour lymphangiogenesis is a possible predictor of sentinel lymph node status in cutaneous melanoma: a case-control study. J Clin Pathol. 2006;59(2):166–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Nguyen Huu S, Oster M, Avril MF, Boitier F, Mortier L, Richard MA, et al. Fetal microchimeric cells participate in tumour angiogenesis in melanomas occurring during pregnancy. Am J Pathol. 2009;174(2):630–7.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Cirello V, Fugazzola L. Novel insights into the link between fetal cell microchimerism and maternal cancers. J Cancer Res Clin Oncol. 2016;142(8):1697–704.

    Article  PubMed  Google Scholar 

  43. Reintgen DS, McCarty KSJ, Vollmer R, Cox E, Seigler HF. Malignant melanoma and pregnancy. Cancer. 1985 Mar;55(6):1340–4.

    Article  CAS  PubMed  Google Scholar 

  44. 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;22(21):4369–75.

    Article  PubMed  Google Scholar 

  45. Tellez A, Rueda S, Conic RZ, Powers K, Galdyn I, Mesinkovska NA, et al. Risk factors and outcomes of cutaneous melanoma in women less than 50 years of age. J Am Acad Dermatol. 2016;74(4):731–8.

    Article  PubMed  Google Scholar 

  46. Driscoll MS, Martires K, Bieber AK, Pomeranz MK, Grant-Kels JM, Stein JA. Pregnancy and melanoma. J Am Acad Dermatol. 2016;75(4):669–78.

    Article  PubMed  Google Scholar 

  47. Martires KJ, Pomeranz MK, Stein JA, Grant-Kels JM, Driscoll MS. Pregnancy-associated melanoma (PAMM): is there truly a worse prognosis? Would not sound alarm bells just yet. J Am Acad Dermatol. 2016;75(2):e77.

    Article  PubMed  Google Scholar 

  48. Martires KJ, Stein JA, Grant-Kels JM, Driscoll MS. Meta-analysis concerning mortality for pregnancy-associated melanoma. J Eur Acad Dermatol Venereol. 2016;30(10):e107–e8.

    Article  CAS  PubMed  Google Scholar 

  49. Kyrgidis A, Lallas A, Moscarella E, Longo C, Alfano R, Argenziano G. Does pregnancy influence melanoma prognosis? A meta-analysis. Melanoma Res. 2017;27(4):289–99.

    Article  PubMed  Google Scholar 

  50. Riker, A. Chapter 14 – Melanoma in pregnancy in melanoma: a modern multidisciplinary approach (1st ed.). In: Riker A (ed). Melanoma A Modern Disciplinary Approach. Springer International Publishing. 2018; p. 239–251.

    Google Scholar 

  51. Wong JH, Sterns EE, Kopald KH, Nizze JA, Morton DL. Prognostic significance of pregnancy in stage I melanoma. Arch Surg. 1989;124(10):1227–30.

    Article  CAS  PubMed  Google Scholar 

  52. Travers RL, Sober AJ, Berwick M, Mihm MC Jr, Barnhill RL, Duncan LM. Increased thickness of pregnancy-associated melanoma. Br J Dermatol. 1995;132(6):876–83.

    Article  CAS  PubMed  Google Scholar 

  53. Daryanani D, Plukker JT, De Hullu JA, Kuiper H, Nap RE, Hoekstra HJ. Pregnancy and early-stage melanoma. Cancer. 2003;97(9):2248–53.

    Article  PubMed  Google Scholar 

  54. 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;22(21):4369–75.

    Article  PubMed  Google Scholar 

  55. O’Meara AT, Cress R, Xing G, Danielsen B, Smith LH. Malignant melanoma in pregnancy. A population-based evaluation. Cancer. 2005;103(6):1217–26.

    Article  PubMed  Google Scholar 

  56. de Haan J, Lok CA, de Groot CJ, Crijns MB, Van Calsteren K, Dahl Steffensen K, et al. Melanoma during pregnancy: a report of 60 pregnancies complicated by melanoma. Melanoma Res. 2017;27(3):218–23.

    Article  PubMed  Google Scholar 

  57. Moller H, Purushotham A, Linklater KM, Garmo H, Holmberg L, Lambe M, et al. Recent childbirth is an adverse prognostic factor in breast cancer and melanoma, but not in Hodgkin lymphoma. Eur J Cancer. 2013 Nov;49(17):3686–93.

    Article  PubMed  Google Scholar 

  58. Alexander A, Samlowski WE, Grossman D, Bruggers CS, Harris RM, Zone JJ, et al. Metastatic melanoma in pregnancy: risk of transplacental metastases in the infant. J Clin Oncol. 2003;21(11):2179–86.

    Article  PubMed  Google Scholar 

  59. Dildy GA III, Moise KJ, Carpenter RJ Jr, et al. Maternal malignancy metastatic to the products of conception: a review. Obstet Gynecol Surv. 1989;44:5.

    Article  Google Scholar 

  60. Fabian M, Toth V, Somlai B, et al. Retrospective analysis of clinicopathologic characteristics of pregnancy associated melanoma. Pathol Oncol Res. 2015;21:1265–71.

    Article  PubMed  Google Scholar 

  61. Kouba DJ, LoPiccolo MC, Alam M, et al. Guidelines for the use of local anesthesia in office-based dermatologic surgery. J Am Acad Dermatol. 2016;74:1201.

    Article  PubMed  Google Scholar 

  62. Murase JE, Heller MM, Butler DC. Safety of dermatologic medications in pregnancy and lactation: Part I. Pregnancy. J Am Acad Dermatol. 2014;70:401.e1.

    Article  CAS  Google Scholar 

  63. American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice. Committee Opinion No. 656: guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol. 2016;127:e75.

    Article  Google Scholar 

  64. Crisan D, Treiber N, Kull T, et al. Surgical treatment of melanoma in pregnancy: a practical guideline. J Dtsch Dermatol Ges. 2016;14:585.

    PubMed  Google Scholar 

  65. Schwartz JL, Mozurkewich EL, Johnson TM. Current management of patients with melanoma who are pregnant, want to get pregnant, or do not want to get pregnant. Cancer. 2003;97:2130.

    Article  PubMed  Google Scholar 

  66. Peccatori FA, Azim HA Jr, Orecchia R, et al. Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(Suppl 6):vi160.

    Article  PubMed  Google Scholar 

  67. Ribero S, Longo C, Dika E, et al. Pregnancy and melanoma: a European-wide survey to assess current management and a critical literature overview. J Eur Acad Dermatol Venereol. 2017;31:65.

    Article  CAS  PubMed  Google Scholar 

  68. Oude Ophuis CM, Verhoef C, Rutkowski P, et al. The interval between primary melanoma excision and sentinel node biopsy is not associated with survival in sentinel node positive patients - an EORTC melanoma group study. Eur J Surg Oncol. 2016;42:1906.

    Article  CAS  PubMed  Google Scholar 

  69. Broer N, Buonocore S, Goldberg C, et al. A proposal for the timing of management of patients with melanoma presenting during pregnancy. J Surg Oncol. 2012;106:36.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Beyeler M, Hafner J, Beinder E, Fauchere JC, Stoeckli SJ, Fehr M, et al. Special considerations for stage IV melanoma during pregnancy. Arch Dermatol. 2005;141(9):1077–9.

    Article  PubMed  Google Scholar 

  71. Maleka A, Enblad G, Sjors G, Lindqvist A, Ullenhag GJ. Treatment of metastatic malignant melanoma with vemurafenib during pregnancy. J Clin Oncol. 2013;31(11):e192–3.

    Article  PubMed  Google Scholar 

  72. Grunewald S, Jank A. New systemic agents in dermatology with respect to fertility, pregnancy, and lactation. J Dtsch Dermatol Ges. 2015;13:277.

    PubMed  Google Scholar 

  73. DiSano JA, Schaefer EW, Kjerulff K, Hollenbeak CS, Pameijer CR. Pregnancy after a melanoma diagnosis in women in the United States. J Surg Res. 2018 Nov;231:133–9.

    Article  PubMed  Google Scholar 

  74. Langagergaard V. Birth outcome in women with breast cancer, cutaneous malignant melanoma, or Hodgkin’s disease: a review. Clin Epidemiol. 2010;3:7–19.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Karagas MR, Stukel TA, Dykes J, et al. A pooled analysis of 10 case-control studies of melanoma and oral contraceptive use. Br J Cancer. 2002;86:1085.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jane M. Grant-Kels .

Editor information

Editors and Affiliations

Ethics declarations

None.

Funding Sources

None.

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Cartron, A.M., Grant-Kels, J.M., Driscoll, M.S. (2021). Melanoma in Pregnancy. In: Alani, R.M., Sahni, D. (eds) Melanoma in Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-82639-0_21

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-82639-0_21

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-82638-3

  • Online ISBN: 978-3-030-82639-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics