1. Women diagnosed with melanoma during pregnancy or within 1Â year of delivery were significantly more likely to have metastatic or recurrent disease.
2. Women diagnosed during or near pregnancy experienced higher odds of mortality.
Evidence Rating Level: 2 (Good)
Study Rundown: Melanoma is the most dangerous type of skin cancer and is on the rise in the United States. Over the past few decades, the incidence increased from 7 cases per 100 000 women in 1975 to 18 cases per 100 000 women in 2011. This surge is thought to be largely due to a rapid increase in the incidence of melanoma among women ages 20 to 40 years old. Melanoma recently surpassed breast cancer as the most common malignancy diagnosed during pregnancy. Few studies have assessed the impact of pregnancy on the prognosis of malignant melanoma and existent studies are small and produce mixed results. In this single-center, case-control study, researchers investigated the staging, risk factors, and outcomes of melanoma in reproductive-age women and specifically analyzed outcomes for women diagnosed during or within one year of pregnancy.
Women with pregnancy-associated melanoma were found to be significantly more likely to have metastatic and recurrent disease. Strengths of this study included investigation of an understudied population and incorporation of the postpartum period in the definition of pregnancy-associated melanoma. Limitations included case-control study and small sample size. Prospective multi-center investigation could assess reproducibility.
Click to read the study in JAAD
Relevant Reading: Cancer during pregnancy and the postpartum period
In-Depth [case-control study]: Female patients <50 years old with biopsy-proven melanoma diagnosed from 1988-2012 and ≥2 years of clinical follow-up (n = 462) at a single center were included in this retrospective analysis. Women with pregnancy-associated melanoma, defined as diagnosis during pregnancy or within 1 year after delivery (n = 41), were compared to a control group of non-pregnant women with melanoma. All-cause mortality, melanoma-specific mortality, recurrence, metastasis, and need for immunotherapy/chemotherapy/radiotherapy were assessed. Sub-analyses were conducted by age group.
Compared to controls, women with pregnancy-associated melanoma had an increased risk of metastatic disease (OR: 6.7, p = 0.01), post-treatment recurrence (OR: 9.3, p = 0.01), and mortality (OR: 5.1, p = 0.03). Across the entire cohort, the average age of women diagnosed with melanoma was 34.7 years. Positive sentinel lymph node status (p < 0.008), metastasis (p < 0.001), and mortality (p < 0.008) were higher for women 40-49 years compared to younger age groups.
Image: PD
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