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Melanoma in Pregnancy

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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.

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Authors and Affiliations

  1. Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA

    Joanna L. Walker M.D., George Kroumpouzos M.D., Ph.D. & Martin A. Weinstock M.D., Ph.D.

  2. Division of Dermatology, Veterans Affairs Medical Center, Providence, RI, USA

    Joanna L. Walker M.D., George Kroumpouzos M.D., Ph.D. & Martin A. Weinstock M.D., Ph.D.

  3. Department of Dermatology, Hawaii Permanente Medical Group, Honolulu, HI, USA

    Annie Wang M.D.

  4. Department of Dermatology, Medical School of Jundiai, Sao Paulo, Brazil

    George Kroumpouzos M.D., Ph.D.

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  1. Joanna L. Walker M.D.
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  1. Louisiana State University, New Orleans, Louisiana, USA

    Adam I. Riker

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Walker, J.L., Wang, A., Kroumpouzos, G., Weinstock, M.A. (2018). Melanoma in Pregnancy. In: Riker, A. (eds) Melanoma. Springer, Cham. https://doi.org/10.1007/978-3-319-78310-9_14

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