1. Home>
2. Specialties>
3. Dermatology>
4. Summary and Comment

Melanoma and Maternity

Melanoma risk is higher than usual during pregnancy and the 6 months thereafter, but women with postcancer pregnancies have good survival rates.

The effect of gestation on cancer has been hotly debated for decades, and the issue, as it relates to melanoma, remains a tremendous concern for dermatologists. Investigators performed a retrospective, population-based cohort study based on linked data from the Norwegian cancer and birth registries. The researchers analyzed cause-specific survival when cancer was diagnosed during pregnancy or the lactation period (~6 months postpartum) and in women with postcancer pregnancies.

Of 42,511 eligible women of childbearing age with a cancer diagnosis, 41,464 were not pregnant, 516 were pregnant, and 531 were in the lactating/postpartum period. Despite breast cancer being the most frequent diagnosis in this age group, malignant melanoma was the most common cancer in the pregnant or lactating women. Melanoma was associated with an increased risk for cause-specific death in pregnant women (hazard ratio, 1.52; P=0.047) but not in lactating women. More head/neck and trunk melanomas occurred in pregnant women (54%) than in nonpregnant women (41%), in whom leg melanomas were the most common type. Interestingly, for all cancer sites combined, women with postcancer pregnancies had a significantly lower risk for cause-specific death than nonpregnant women (HR, 0.49; 95% confidence interval, 0.41–0.59). Women with diagnoses of cervical cancer, lymphoma, or leukemia and a postcancer pregnancy had approximately 80% lower risk than nonpregnant women with such diagnoses for cause-specific death.

Comment: Results of this population-based study will resonate for many clinicians, who do report finding melanomas in pregnant women. This phenomenon might be explained by the darkening of moles during pregnancy, which could lead to more sampling of pigmented lesions. Also, natural physiological changes during pregnancy and clinicians’ reluctance to recommend tests in expectant mothers might result in underdetection of other cancers, such as breast cancer. Circulating growth factors or immunological changes could lead to a heightened rate of melanoma formation; the shift toward a more typically masculine, truncal distribution pattern might reflect a slightly different etiology. The increased death rate is barely significant and needs to be replicated in other studies. Most melanomas that develop during pregnancy do not recur during gestation but afterward, if at all.

Clinicians and young patients who want to become pregnant after having melanoma can be assured that patients with postcancer pregnancies seem to fare better than other patients. It seems prudent to monitor for mole changes during pregnancy and to fully discuss relapse risks for patients intending to become pregnant soon after a melanoma diagnosis.

— Hensin Tsao, MD, PhD

Published in Journal Watch Dermatology April 3, 2009

Citation(s):

Stensheim H et al. Cause-specific survival for women diagnosed with cancer during pregnancy or lactation: A registry-based cohort study. J Clin Oncol 2009 Jan 1; 27:45.

• Original article (Subscription may be required)
• Medline abstract (Free)

Reader Remarks:

Read all Reader Remarks on this article

• melanoma and maternity
  George B Howell, CCCHC, Miles City, Mt, 6 Apr 2009 2:14 PM EST
  helpful brief