 |
Current Concepts: Melanoma, Pregnancy, and Hormone Use
|
 |
|
| |
Submitted By: Jennifer Schwartz, M.D.
Article authored by Jennifer L. Schwartz, M.D.(1), Timothy M. Johnson, M.D.(1,2,3)
1)Departments of Dermatology, 2) Otorhinolaryngology, and 3)Surgery (Division of Plastic Surgery), University of Michigan Medical School and Comprehensive Cancer Center Melanoma Program, Ann Arbor, Michigan
The incidence of melanoma, the most deadly form of skin cancer, continues to increase and it is projected that 1 in 67 Americans born in the year 2003 will develop an invasive melanoma in their lifetime. Melanoma is the 7th most frequently diagnosed cancer in women, and is the most commonly diagnosed cancer in women ages 25-29 years(1). Consequently, melanoma is one of the most common types of cancer that arise during pregnancy(2). Controversy has surrounded the issue of the effects of hormones and pregnancy on melanoma. Opinions vary among doctors regarding prognosis and management of melanoma in pregnant patients and also, safety of pregnancy, oral contraceptive use, and hormone replacement therapy in patients with a history of melanoma. Do patients diagnosed with melanoma during pregnancy have a poorer prognosis? How is melanoma treated in pregnant patients and what are the implications for the baby? Can melanoma spread to the baby? How long should a patient wait after diagnosis and treatment of melanoma before getting pregnant? Can oral contraception and hormone replacement therapy be used safely after a diagnosis of melanoma? The medical literature helps shed light on these issues.
Melanoma and pregnancy
Do patients diagnosed with melanoma during pregnancy have a poorer prognosis?
Patients pregnant at the time of diagnosis of melanoma, when it is localized in the skin, have the same prognosis as women who are not pregnant(3,4). Prognosis, as in all patients with localized melanoma, depends primarily on how deep the melanoma extends into the skin. Early detection of melanoma is critical in all people, but, unfortunately, in pregnant women, physicians may delay biopsy of a suspicious spot until after delivery. Biopsies of worrisome spots can be performed safely during pregnancy and should not be delayed. Moles which change in size, shape, or color, persistently itch, or are new and look different than other spots should be evaluated by a doctor.
How is melanoma treated in pregnant patients and what are the implications for the baby?
Wide excision around the melanoma site is standard care for all patients with melanoma localized to the skin and can be safely performed in pregnancy. Sometimes, obstetricians have special recommendations for the surgeon, for example, monitoring the baby’s heart rate before and after the surgery.
The lymph nodes are the most common location to find early spread of melanoma from the skin. Sentinel lymph node biopsy, a procedure to evaluate the lymph nodes in patients with localized melanoma at least 1 mm thick, also can be performed safely during pregnancy. To identify the lymph node/s to remove and test for melanoma, radioactive material and blue dye are injected in the skin around the melanoma site. These flow to the sentinel lymph node/s that the surgeon removes and sends to the pathologist to examine. The dose of radioactive material used in this procedure carries negligible risk to the baby. However, the dye can very occasionally cause severe allergic reaction in a patient and if that occurs in a pregnant woman, could be harmful to the baby. Therefore, some surgeons use only the radioactive material to identify the sentinel lymph node/s.
Can melanoma spread to the baby?
Melanoma spreading to the baby is a very rare event(5) This occurs almost exclusively in pregnant patients with advanced melanoma in the lymph nodes and internal organs.
How long should a patient wait after diagnosis and treatment of melanoma before getting pregnant?
There are no standard guidelines on the length of time to wait after the diagnosis of melanoma before getting pregnant. There is no definite evidence to suggest that pregnancy following a diagnosis of melanoma changes prognosis. However, some patients diagnosed with and treated for localized melanoma in the skin will develop recurrence in the lymph nodes and/or internal organs. Recurrences happen because of spread that could not be detected at the time of initial diagnosis and treatment of melanoma in the skin. When recurrence in the lymph nodes and/or internal organs happens during pregnancy, it is even more devastating emotionally and carries a potential, although small, risk of spread to the baby. Furthermore, treatments for advanced melanoma in a pregnant patient often have adverse consequences for the baby. How long to wait before getting pregnant after a diagnosis of melanoma should be based on the risk of recurrence weighed against the age of the patient and the desire to get pregnant. There are no set guidelines but patients typically wait 0 – 5 years after a discussion of the risks with their doctor. For example, a young woman with a deep melanoma in the skin at intermediate or high risk of spread typically waits 3 – 5 years. A woman with a very thin melanoma at low risk of spread, however, may not need to wait.
Melanoma and hormones
Can oral contraception and hormone replacement therapy be used safely after a diagnosis of melanoma?
There does not appear to be any increased risk of developing melanoma from using oral contraception or hormone replacement(6). A very small increased risk of recurrence, in women diagnosed with melanoma using oral contraception or hormone replacement, has not yet been excluded because there is no large study to date to verify this. Some doctors believe this risk to be so minimal that a history of melanoma is not a major contraindication to placing a woman on oral contraception or hormone replacement. Other doctors may recommend nonhormonal contraception or menopause symptom relief.
Summary
Pregnancy or hormone use before, during, or after diagnosis of melanoma does not appear to influence survival. However, each patient is unique and management should be tailored by their doctors. Patients diagnosed with melanoma during pregnancy benefit from a team of doctors including obstetricians, dermatologists, surgeons, and oncologists.
Correspondence to Jennifer L. Schwartz, Department of Dermatology, University of Michigan, 1910 Taubman Center, Ann Arbor, MI 48109-0314
Phone: 734-936-4190
Fax: 734-936-6395
email: Jennifer L. Schwartz (jennschw@umich.edu)
|
|
|
|
Additional Authors: |
|
|
|
|
Works Cited: |
|
|
|
| |
1. Jemal A, Murray T, Samuels A, Ghafoor A, Ward E, Thun MJ. Cancer statistics, 2003. CA Cancer J Clin. 2003;53:5-26.
2. Pavlidis NA. Coexistence of pregnancy and malignancy. The Oncologist. 2002;7:279-287.
3. Daryanani D, Plukker JTh, De Hullu JA, Kuiper H, Nap RE, Hoekstra HJ. Pregnancy and early-stage melanoma. Cancer. 2003;97:2248-2253.
4. Grin CM, Driscoll MS, Grant-Kels JM. The relationship of pregnancy, hormones, and melanoma. Semin Cutan Med Surg. 1998;17:167-171.
5. Altman JF, Lowe L, Redman B, et al. Placental metastasis of maternal melanoma. J Am Acad Dermatol. (in press)
Karagas MR, Stukel TA, Dykes J, et al. A pooled analysis of 10 case-control studies of melanoma and oral contraceptive use. Br J Cancer. 2002;86:1085-1092.
|
|
|
|
|
Article Links: |
|
|
|
|
|
|
|
|
|
|
|
|
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
|
|
|
|
|
These review articles are the opinions of the authors. Some of the views may be controversial.
CancerNews.com™ does not directly endorse the work. We merely present it as part of our service.
Please read the disclaimer.
|
|
|
|
|
|
|
|
|
|
Team5 Corporation located in Manhattan (New York) is a Web Development company specializing in
large scale database driven web sites.
{www.team5.com}
|
|
|
|
|
Search for great prices on apparel, electronics, sporting goods and more.
Buy online and save.
{www.shoppingnews.com}
|
|
|
|
