Melanoma is one of the most common types of cancer. Melanoma incidence is also increasing in younger women. This is shown, among other things, by data from the U.S. SEER registry. Therefore, an Ohio research group set out to review former Cleveland Clinic patients with melanoma for specifics regarding histopathology, staging, risk factors, and outcomes. The results on pregnancy-associated melanoma are striking. Here, the study comes to a rather surprising conclusion.
Included in the retro-spective study were all female patients under the age of 50 who had biopsy-confirmed melanoma between 1988 and 2012. The follow-up period had to be at least two years. 462 patients met the inclusion criteria, and the mean age was 35 years.
Women over 40 had a significantly worse outcome compared with younger patients: disease was more likely to metastasize and there were more positive sentinel lymph nodes; there were also more recurrences and deaths. Invasive melanomas were significantly less frequent in the group of female patients ≤19 years (p<0.0008).
Poor prognosis in pregnancy
Compared with nonpregnant women, the 41 patients with pregnancy-associated melanoma had a statistically relevant worse prognosis. Mortality was increased fivefold, as were recurrences (ninefold increase) and metastases (sevenfold increase).
Based on the results, the authors advise not only improved melanoma screening in young women in general, but also close follow-up and recurrence monitoring in patients with melanoma during pregnancy or the year after. How dangerous melanoma actually is during pregnancy and breastfeeding has been controversially discussed again and again in recent years – with varying results [1,2]. Currently, the consensus is that pregnancy-associated melanoma does not lead to a worse prognosis. According to the authors, this statement should be reconsidered in light of the results of the present study. Melanoma in pregnancy may require a new risk assessment after all.
Source: Tellez A, et al: Risk factors and outcomes of cutaneous melanoma in women less than 50 years of age. JAAD 2016. DOI: http://dx.doi.org/10.1016/j.jaad.2015.11.014 [Epub ahead of print].
Literature:
- 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(1): 45-51.
- Johansson A, et al: Mortality in women with pregnancy-associated malignant melanoma. J Am Acad Dermatol 2014 Dec; 71(6): 1093-1101.
InFo ONCOLOGY & HEMATOLOGY 2016; 4(3): 3.
