Management of Melanoma During Pregnancy

Sancy A. Leachman, MD, PhD; Ryan Jackson, HBS; Mark J. Eliason, MD; April A. Larson, MD; Jean L. Bolognia, MD

Disclosures

Dermatology Nursing. 2007;19(2):145-152,161. 

In This Article

Pregnancy After Melanoma

How long should a prospective mother wait to become pregnant after being treated for stage I or II melanoma? While there are no standard recommendations to address this issue, the recurrence of melanoma during pregnancy clearly has significant medical and emotional complexities for all parties involved.

Schwartz et al. (2003) proposed that patients be advised as to how long to wait until becoming pregnant based on the likelihood of recurrence and the age of the patient (estimated years with childbearing potential). Women with very thin lesions with a low probability of recurrence might be advised to wait 2 years, while a patient with a thicker lesion should wait 3 to 5 years. Another study by Mackie et al. (1991) compared 92 women diagnosed with melanoma during their childbearing years with 296 matched controls. All the women were diagnosed with stage I disease. They advised that women who wished to become pregnant receive advice based upon the thickness of their tumor, evidence of vascular spread, and body site. Less than 10% of women with tumors < 1.5 mm in depth had a recurrence in 5 years, but when the tumor depth was between 1.5 and 3.5 mm, there was a 30% 5-year mortality rate. Survival dropped to less than 50% if the lesions were > 3.5 mm in depth. When the authors examined 142 patients with stage II melanoma, they found that 83% of the patients who developed recurrent disease experienced a recurrence within 2 years of their initial treatment. Based on these data, this group recommended that patients with stage I or II melanoma wait 2 years following surgery before becoming pregnant again. In translating these results to current practice, it is important to note that MacKie et al. (1991) did not specify the criteria they used to determine staging. Their recommendations are supported by the work by Schwartz et al. (2003) who concur with this guideline, and also emphasize the need to tailor recommendations to the individual patient's life issues, taking into consideration the age of the patient and the effect of waiting on the potential to be able to become pregnant.

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