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Pregnancy-associated malignant melanoma linked to worse prognosis

Women who were diagnosed with metastatic melanoma within 1 year after pregnancy had higher likelihood of recurrence and mortality compared with a control group of nonpregnant women with the disease, according to recently published study results.

Researchers studied 462 women (mean age, 34.7 years) diagnosed with biopsy-proven melanoma between 1988 and 2012. Follow-up was at least 2 years (mean length, 91 months).

Breslow level was available for 92% of patients, with a mean Breslow level of 1.14 mm. The trunk was the most common anatomic location of the melanoma (38%), followed by lower extremities (33%), and upper extremities (20%).

Women who presented at age 20 to 49 years most frequently had stage I melanoma with approximately half of the cases (P < .001), while a higher proportion of women 19 years of age or younger presented with stage 0 melanoma (P < .0008).

Women aged 40 to 49 years had higher positive sentinel lymph node status (P < .008), recurrence rates, metastatic disease (P < .001) and death rates (P < .008).

There were 41 women with pregnancy-associated malignant melanoma (PAMM; diagnosed during or within 1 year after pregnancy), with a mean age of 32.6 years at time of melanoma diagnosis, compared with 34.7 years for the control group of nonpregnant women (P = .04). The women in the PAMM cohort had a significantly worse prognosis compared with the control group, including a higher incidence of recurrence (12.5 % vs. 1.4%; P < .001), metastasis (25% vs. 12.7%, P = .03), and trend toward higher incidence of melanoma mortality (20% vs. 10.3%; P = .06).

“After adjusting for stage, age, and location, this study showed an overwhelming 5-fold, 7-fold and 9-fold increase in mortality, metastasis and recurrence, respectively, in women given the diagnosis of [metastatic melanoma] within 1 year after pregnancy,” the researchers wrote. “To our knowledge, this is the first study that shows a decrease in survival for PAMM [despite adjustments].”

“It may be recommended for women with PAMM to be made aware of the importance of vigilant monthly self-skin examinations,” the researchers concluded. “For physicians of patients with PAMM we suggest instructing patients to seek timely evaluation of any changing or new lesions noted during or immediately after pregnancy.”  – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.