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Melanoma pp 239-252 | Cite as

Melanoma in Pregnancy

  • Joanna L. Walker
  • Annie Wang
  • George Kroumpouzos
  • Martin A. Weinstock
Chapter

Abstract

Pregnancy may transiently alter clinical features of benign melanocytic nevi (BMN) but does not increase the rate of malignant transformation. Changes in size and/or pigment network are minor, infrequent, and typically associated with anatomic sites prone to skin stretching in pregnancy. Females with dysplastic nevus syndrome (DNS) may have elevated risk of malignant transformation and should be monitored closely during pregnancy. Approximately 8% of malignant melanoma (MM) cases occur during pregnancy; therefore, screening, evaluation, and biopsy of suspicious lesions are paramount to avoid delayed diagnosis of MM during pregnancy. It is unclear whether pregnancy worsens outcome or survival for MM; translational and clinical studies show complex and conflicting trends. Two recent meta-analyses report a 17–56% elevated risk of mortality for pregnancy-associated malignant melanoma (PAMM); however, controversy still exists among experts as data is limited and analysis methods have been criticized. Early-stage PAMM does not cause poor fetal or maternal pregnancy outcomes, but metastatic MM is the most common cancer to spread to the placenta and fetus. PAMM should be treated according to standard guidelines for MM whenever possible, with expeditious surgery the main treatment modality for localized MM. The safety of systemic targeted and immunotherapy for MM in pregnancy is unknown; expert multidisciplinary teams should manage advanced-stage PAMM. Pregnancy following diagnosis and treatment of MM does not have any fetal or maternal adverse effects, but counseling should be individualized based on stage of disease and maternal preferences in cases with high risk for recurrence or metastasis.

Keywords

Malignant melanoma Pregnancy Pregnancy-associated melanoma Melanocytic nevi Management Prognosis Review 

References

  1. 1.
    Walker JL, Wang AR, Kroumpouzos G, Weinstock MA. Cutaneous tumors in pregnancy. Clin Dermatol. 2016;34(3):359–67.CrossRefPubMedGoogle Scholar
  2. 2.
    Nading MA, Nanney LB, Boyd AS, Ellis DL. Estrogen receptor beta expression in nevi during pregnancy. Exp Dermatol. 2008;17(6):489–97.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Ellis DL. Pregnancy and sex steroid hormone effects on nevi of patients with the dysplastic nevus syndrome. J Am Acad Dermatol. 1991;25(3):467–82.CrossRefPubMedGoogle Scholar
  4. 4.
    Foucar E, Bentley TJ, Laube DW, Rosai J. A histopathologic evaluation of nevocellular nevi in pregnancy. Arch Dermatol. 1985;121(3):350–4.CrossRefPubMedGoogle Scholar
  5. 5.
    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.CrossRefPubMedGoogle Scholar
  6. 6.
    Wyon Y, Synnerstad I, Fredrikson M, Rosdahl I. Spectrophotometric analysis of melanocytic naevi during pregnancy. Acta Derm Venereol. 2007;87(3):231–7.PubMedGoogle Scholar
  7. 7.
    Akturk AS, Bilen N, Bayramgurler D, Demirsoy EO, Erdogan S, Kiran R. Dermoscopy is a suitable method for the observation of the pregnancy-related changes in melanocytic nevi. J Eur Acad Dermatol Venereol. 2007;21(8):1086–90.CrossRefPubMedGoogle Scholar
  8. 8.
    Rubegni P, Sbano P, Burroni M, Cevenini G, Bocchi C, Severi FM, et al. Melanocytic skin lesions and pregnancy: digital dermoscopy analysis. Skin Res Technol. 2007;13(2):143–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Zampino MR, Corazza M, Costantino D, Mollica G, Virgili A. Are melanocytic nevi influenced by pregnancy? A dermoscopic evaluation. Dermatol Surg. 2006;32(12):1497–504.PubMedGoogle Scholar
  10. 10.
    Sanchez JL, Figueroa LD, Rodriguez E. Behavior of melanocytic nevi during pregnancy. Am J Dermatopathol. 1984;6(Suppl):89–91.PubMedGoogle Scholar
  11. 11.
    Strumia R. Digital epiluminescence microscopy in nevi during pregnancy. Dermatology. 2002;205(2):186–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Gunduz K, Koltan S, Sahin MT, EF E. Analysis of melanocytic naevi by dermoscopy during pregnancy. J Eur Acad Dermatol Venereol. 2003;17(3):349–51.CrossRefPubMedGoogle Scholar
  13. 13.
    Pennoyer JW, Grin CM, Driscoll MS, Dry SM, Walsh SJ, Gelineau JP, et al. Changes in size of melanocytic nevi during pregnancy. J Am Acad Dermatol. 1997;36(3 Pt 1):378–82.CrossRefPubMedGoogle Scholar
  14. 14.
    Tierney EKG, Tumors RGS. In: Kroumpouzos G, editor. Text atlas of obstretric dermatology. Philadelphia: Lippincott Williams & Wilkins Publishers; 2013. p. 141–51.Google Scholar
  15. 15.
    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.CrossRefPubMedGoogle Scholar
  16. 16.
    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.CrossRefPubMedGoogle Scholar
  17. 17.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Eibye S, Kjaer SK, Mellemkjaer L. Incidence of pregnancy-associated cancer in Denmark, 1977–2006. Obstet Gynecol. 2013;122(3):608–17.CrossRefPubMedGoogle Scholar
  19. 19.
    Lens M, Rosdahl I, Newton-Bishop J. Cutaneous melanoma during pregnancy: is the controversy over? J Clin Oncol. 2009;27(19):e11–2; author reply e3–4CrossRefPubMedGoogle Scholar
  20. 20.
    Jones MS, Lee J, Stern SL, Faries MBI. Pregnancy-associated melanoma associated with adverse outcomes? J Am Coll Surg. 2017;225(1):149–58.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Peccatori FA, Azim HA Jr, Orecchia R, Hoekstra HJ, Pavlidis N, Kesic V, et al. Cancer, pregnancy and fertility: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(Suppl 6):vi160–70.CrossRefPubMedGoogle Scholar
  22. 22.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Bleyer WA. Cancer in older adolescents and young adults: epidemiology, diagnosis, treatment, survival, and importance of clinical trials. Med Pediatr Oncol. 2002;38(1):1–10.CrossRefPubMedGoogle Scholar
  24. 24.
    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.CrossRefPubMedGoogle Scholar
  25. 25.
    Khosrotehrani K, Nguyen Huu S, Prignon A, Avril MF, Boitier F, Oster M, et al. Pregnancy promotes melanoma metastasis through enhanced lymphangiogenesis. Am J Pathol. 2011;178(4):1870–80.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Johansen LL, Lock-Andersen J, Hviid TV. The pathophysiological impact of HLA class Ia and HLA-G expression and regulatory T cells in malignant melanoma: a review. J Immunol Res. 2016;2016:6829283.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    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.CrossRefPubMedGoogle Scholar
  29. 29.
    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.CrossRefPubMedGoogle Scholar
  30. 30.
    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.CrossRefPubMedGoogle Scholar
  31. 31.
    Roh MR, Eliades P, Gupta S, Tsao H. Cutaneous melanoma in women. Int J Womens Dermatol. 2015;1(1):21–5.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 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.CrossRefPubMedGoogle Scholar
  33. 33.
    Zhou JH, Kim KB, Myers JN, Fox PS, Ning J, Bassett RL, et al. Immunohistochemical expression of hormone receptors in melanoma of pregnant women, nonpregnant women, and men. Am J Dermatopathol. 2014;36(1):74–9.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    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.CrossRefPubMedGoogle Scholar
  35. 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.CrossRefPubMedGoogle Scholar
  36. 36.
    Lens MB, Reiman T, Husain AF. Use of tamoxifen in the treatment of malignant melanoma. Cancer. 2003;98(7):1355–61.CrossRefPubMedGoogle Scholar
  37. 37.
    Bardin A, Boulle N, Lazennec G, Vignon F, Pujol P. Loss of ERbeta expression as a common step in estrogen-dependent tumor progression. Endocr Relat Cancer. 2004;11(3):537–51.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    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.CrossRefPubMedGoogle Scholar
  39. 39.
    Prithviraj P, Anaka M, McKeown SJ, Permezel M, Walkiewicz M, Cebon J, et al. Pregnancy associated plasma protein-A links pregnancy and melanoma progression by promoting cellular migration and invasion. Oncotarget. 2015;6(18):15953–65.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Rodero MP, Prignon A, Avril MF, Boitier F, Aractingi S, Khosrotehrani K. Increase lymphangiogenesis in melanoma during pregnancy: correlation with the prolactin signalling pathway. J Eur Acad Dermatol Venereol. 2013;27(1):e144–5.CrossRefPubMedGoogle Scholar
  41. 41.
    Dadras SS, Lange-Asschenfeldt B, Velasco P, Nguyen L, Vora A, Muzikansky A, et al. Tumor lymphangiogenesis predicts melanoma metastasis to sentinel lymph nodes. Mod Pathol. 2005;18(9):1232–42.CrossRefGoogle Scholar
  42. 42.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    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.CrossRefPubMedGoogle Scholar
  44. 44.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Conybeare RC. Malignant melanoma and pregnancy: report of 3 cases. Obstet Gynecol. 1964;24:451–4.CrossRefPubMedGoogle Scholar
  46. 46.
    Riberti C, Marola G, Bertani A. Malignant melanoma: the adverse effect of pregnancy. Br J Plast Surg. 1981;34(3):338–9.CrossRefPubMedGoogle Scholar
  47. 47.
    Pack GT, Scharnagel IM. The prognosis for malignant melanoma in the pregnant woman. Cancer. 1951;4(2):324–34.CrossRefPubMedGoogle Scholar
  48. 48.
    Slingluff CL Jr, Reintgen DS, Vollmer RT, Seigler HF. Malignant melanoma arising during pregnancy. A study of 100 patients. Ann Surg. 1990;211(5):552–7. discussion 8-9CrossRefPubMedPubMedCentralGoogle Scholar
  49. 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.CrossRefPubMedGoogle Scholar
  50. 50.
    Mendizabal E, De Leon-Luis J, Gomez-Hidalgo NR, Joigneau L, Pintado P, Rincon P, et al. Maternal and perinatal outcomes in pregnancy-associated melanoma. Report of two cases and a systematic literature review. Eur J Obstet Gynecol Reprod Biol. 2017;214:131–9.CrossRefPubMedGoogle Scholar
  51. 51.
    Byrom L, Olsen C, Knight L, Khosrotehrani K, Green AC. Increased mortality for pregnancy-associated melanoma: systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2015;29(8):1457–66.CrossRefPubMedGoogle Scholar
  52. 52.
    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.CrossRefGoogle Scholar
  53. 53.
    Khosrotehrani K, Olsen CM, Byrom L, Green AC. Melanoma during pregnancy: level of evidence and principles of precaution. J Am Acad Dermatol. 2017;76(1):e29–e30.CrossRefPubMedGoogle Scholar
  54. 54.
    Kyrgidis A, Argenziano G, Moscarella E, Longo C, Alfano R, Lallas A. Increased mortality for pregnancy-associated melanoma: different outcomes pooled together, selection and publication biases. J Eur Acad Dermatol Venereol. 2016;30(9):1618.CrossRefPubMedGoogle Scholar
  55. 55.
    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;22(21):4369–75.CrossRefPubMedGoogle Scholar
  56. 56.
    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.CrossRefPubMedGoogle Scholar
  57. 57.
    Johansson AL, Andersson TM, Plym A, Ullenhag GJ, Moller H, Lambe M. Mortality in women with pregnancy-associated malignant melanoma. J Am Acad Dermatol. 2014;71(6):1093–101.CrossRefPubMedGoogle Scholar
  58. 58.
    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;49(17):3686–93.CrossRefPubMedGoogle Scholar
  59. 59.
    Silipo V, De Simone P, Mariani G, Buccini P, Ferrari A, Catricala C. Malignant melanoma and pregnancy. Melanoma Res. 2006;16(6):497–500.CrossRefPubMedGoogle Scholar
  60. 60.
    Daryanani D, Plukker JT, De Hullu JA, Kuiper H, Nap RE, Hoekstra HJ. Pregnancy and early-stage melanoma. Cancer. 2003;97(9):2248–53.CrossRefPubMedGoogle Scholar
  61. 61.
    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.CrossRefPubMedGoogle Scholar
  62. 62.
    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; discussion 30–1CrossRefPubMedGoogle Scholar
  63. 63.
    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.CrossRefPubMedGoogle Scholar
  64. 64.
    Trapeznikov NN, Khasanov Sh R, Iavorskii VV. Melanoma of the skin and pregnancy. Vopr Onkologii. 1987;33(6):40–6.Google Scholar
  65. 65.
    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.CrossRefPubMedGoogle Scholar
  66. 66.
    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.CrossRefPubMedGoogle Scholar
  67. 67.
    Pages C, Robert C, Thomas L, Maubec E, Sassolas B, Granel-Brocard F, et al. Management and outcome of metastatic melanoma during pregnancy. Br J Dermatol. 2010;162(2):274–81.CrossRefPubMedGoogle Scholar
  68. 68.
    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.CrossRefPubMedGoogle Scholar
  69. 69.
    Miller E, Barnea Y, Gur E, Leshem D, Karin E, Weiss J, et al. Malignant melanoma and pregnancy: Second thoughts. J Plast Reconstr Aesthet Surg. 2010;63(7):1163–8.CrossRefPubMedGoogle Scholar
  70. 70.
    Reintgen DS, McCarty KS Jr, Vollmer R, Cox E, Seigler HF. Malignant melanoma and pregnancy. Cancer. 1985;55(6):1340–4.CrossRefPubMedGoogle Scholar
  71. 71.
    Bleau N, Patenaude V, Abenhaim HA. Risk of venous thrombo-embolic events in pregnant patients with cancer. J Matern Fetal Neonatal Med. 2016;29(3):380–4.PubMedGoogle Scholar
  72. 72.
    Lee YY, Roberts CL, Young J, Dobbins T. Using hospital discharge data to identify incident pregnancy-associated cancers: a validation study. BMC Pregnancy Childbirth. 2013;13:37.CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    Langagergaard V. Birth outcome in women with breast cancer, cutaneous malignant melanoma, or Hodgkin’s disease: a review. Clin Epidemiol. 2010;3:7–19.CrossRefPubMedPubMedCentralGoogle Scholar
  74. 74.
    Langagergaard V, Puho EH, Lash TL, Norgard B, Sorensen HT. Birth outcome in Danish women with cutaneous malignant melanoma. Melanoma Res. 2007;17(1):31–6.CrossRefPubMedGoogle Scholar
  75. 75.
    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.CrossRefGoogle Scholar
  76. 76.
    Eltorky MKV, Osborne P, et al. Placental metastasis from maternal carcinoma: a report of three cases. J Reprod Med. 1995;40:4.Google Scholar
  77. 77.
    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.CrossRefPubMedGoogle Scholar
  78. 78.
    Patenaude Y, Pugash D, Lim K, Morin L, Diagnostic Imaging C, Lim K, et al. The use of magnetic resonance imaging in the obstetric patient. J Obstet Gynaecol Can. 2014;36(4):349–63.CrossRefPubMedGoogle Scholar
  79. 79.
    Andtbacka RH, Donaldson MR, Bowles TL, Bowen GM, Grossmann K, Khong H, et al. Sentinel lymph node biopsy for melanoma in pregnant women. Ann Surg Oncol. 2013;20(2):689–96.CrossRefPubMedGoogle Scholar
  80. 80.
    Hu Y, Melmer PD, Slingluff CL Jr. Localization of the sentinel lymph node in melanoma without blue dye. Ann Surg. 2016;263(3):588–92.CrossRefPubMedPubMedCentralGoogle Scholar
  81. 81.
    Broer N, Buonocore S, Goldberg C, Truini C, Faries MB, Narayan D, et al. A proposal for the timing of management of patients with melanoma presenting during pregnancy. J Surg Oncol. 2012;106(1):36–40.CrossRefPubMedPubMedCentralGoogle Scholar
  82. 82.
    Leachman SA, Jackson R, Eliason MJ, Larson AA, Bolognia JL. Management of melanoma during pregnancy. Dermatol Nurs. 2007;19(2):145–52. 61PubMedGoogle Scholar
  83. 83.
    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.CrossRefPubMedGoogle Scholar
  84. 84.
    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.CrossRefPubMedGoogle Scholar
  85. 85.
    Grunewald S, Jank A. New systemic agents in dermatology with respect to fertility, pregnancy, and lactation. J Dtsch Dermatol Ges. 2015;13:277.PubMedGoogle Scholar
  86. 86.
    Wang SCLY, Piao HL, Hong XW, Zhang D, Xu YY, et al. PD-1 and Tim-3 pathways are associated with regulatory CD8+ T cell function in decidua and maintenance of normal pregnancy. Cell Death Dis. 2015;6:e1738.CrossRefPubMedPubMedCentralGoogle Scholar
  87. 87.
    Ribero S, Longo C, Dika E, Fortes C, Pasquali S, Nagore 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(1):65–9.CrossRefPubMedGoogle Scholar
  88. 88.
    Stensheim H, Cvancarova M, Moller B, Fossa SD. Pregnancy after adolescent and adult cancer: a population-based matched cohort study. Int J Cancer. 2011;129(5):1225–36.CrossRefPubMedGoogle Scholar
  89. 89.
    Byrom L, Olsen CM, Knight L, Khosrotehrani K, Green AC. Does pregnancy after a diagnosis of melanoma affect prognosis? Systematic review and meta-analysis. Dermatol Surg. 2015;41(8):875–82.CrossRefPubMedGoogle Scholar
  90. 90.
    Brady MS, Noce NS. Pregnancy is not detrimental to the melanoma patient with clinically localized disease. J Clin Aesthet Dermatol. 2010;3(3):22–8.PubMedPubMedCentralGoogle Scholar
  91. 91.
    Albersen M, Westerling VI, van Leeuwen PA. The influence of pregnancy on the recurrence of cutaneous malignant melanoma in women. Dermatol Res Pract. 2010;2010Google Scholar
  92. 92.
    MacKie RM, Bufalino R, Morabito A, Sutherland C, Cascinelli N. Lack of effect of pregnancy on outcome of melanoma. For the World Health Organisation Melanoma Programme. Lancet. 1991;337(8742):653–5.CrossRefPubMedGoogle Scholar
  93. 93.
    Karagas MR, Zens MS, Stukel TA, Swerdlow AJ, Rosso S, Osterlind A, et al. Pregnancy history and incidence of melanoma in women: a pooled analysis. Cancer Causes Control. 2006;17(1):11–9.CrossRefPubMedGoogle Scholar
  94. 94.
    Naldi LAA, Imberti GL, Giordano L, Gallus S, La Vecchia C. Oncology Study Group of the Italian Group for Epidemiologic Research in Dermatology (GISED). Cutaneous malignant melanoma in women. Phenotypic characteristics, sun exposure, and hormonal factors: a case-control study from Italy. Ann Epidemiol. 2005;15:5.CrossRefGoogle Scholar
  95. 95.
    Lea CSHE, Hartge P, et al. Reproductive risk factors for cutaneous melanoma in women: a case-control study. Am J Epidemiol. 2007;165:8.Google Scholar
  96. 96.
    Mackie RM, Bray CA. Hormone replacement therapy after surgery for stage I or II cutaneous melanoma. Br J Cancer. 2004;90:2.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Joanna L. Walker
    • 1
    • 2
  • Annie Wang
    • 3
  • George Kroumpouzos
    • 1
    • 4
    • 2
  • Martin A. Weinstock
    • 1
    • 2
  1. 1.Department of DermatologyThe Warren Alpert Medical School of Brown UniversityProvidenceUSA
  2. 2.Division of DermatologyVeterans Affairs Medical CenterProvidenceUSA
  3. 3.Department of DermatologyHawaii Permanente Medical GroupHonoluluUSA
  4. 4.Department of DermatologyMedical School of JundiaiSao PauloBrazil

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