Prognosis Is Poor for Women With Pregnancy-Associated Melanoma

Prognosis Is Poor for Women With Pregnancy-Associated Melanoma
Prognosis Is Poor for Women With Pregnancy-Associated Melanoma

Women younger than 50 years who are pregnant or were recently pregnant have a higher risk of death from melanoma. These findings were published in the Journal of the American Academy of Dermatology (doi:10.1016/j.jaad.2015.11.014).

Melanoma is the fifth most common cancer in the United States, and its incidence is increasing among young women, according to background information in the study. This retrospective study used electronic medical records to investigate women younger than 50 years with a biopsy-proven diagnosis of melanoma between 1988 and 2012. It excluded patients with less than 2 years of follow-up data.

The study included 462 patients, mean age was 34.7 years. Invasive melanoma was less common in women 19 years and younger compared with the older women in the study. Women age 40 to 49 years had higher rates of positive sentinel node status, recurrence rates, metastatic disease, and death.

The study included 41 patients with pregnancy-associated melanoma. These women had a significantly worse prognosis compared with the nonpregnant patients: a 9-fold increase in recurrence, 7-fold increase in metastasis, and 5-fold increase in mortality. Pregnancy hormones are suspected of fueling the cancer.

"We saw significant, worse prognoses and outcomes for women with a pregnancy-associated melanoma, compared to a control group of non-pregnant women," said Brian Gastman, MD, a plastic surgeon and director of melanoma surgery at Cleveland Clinic in Ohio, and primary investigator in the study.

Gastman reports that rates of metastasis, recurrence, and death were measurably higher in women with a melanoma diagnosis during pregnancy or within 1 year after delivery.

The study is a stark reminder of the importance of skin cancer prevention. Melanoma rates have been increasing for at least 30 years and doubled in the United States from 1982 to 2011. The authors stated that women younger than 50 years, particularly those who are pregnant and at higher risk of developing melanoma, should be extra vigilant in monitoring changing skin lesions and maintaining dermatologic follow up.

Exposure to ultraviolet radiation (UV) from the sun and artificial sources is the most preventable risk factor for all forms of skin cancer, including melanoma. Skin can be protected from harmful UV rays by seeking shade; wearing protective clothing; and using a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher. Also, avoid use of tanning beds, which have artificial UV radiation that increases melanoma risk, especially in women 45 years and younger.

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