Influence of Pregnancy on Melanoma May Vary By Stage

Pedram Gerami, MD Department of Dermatology Northwestern University Chicago, IL

Dr. Gerami Interview with:
Pedram Gerami, MD
Department of Dermatology
Northwestern University
Chicago, IL

Medical Research: What is the background for this study? What are the main findings?

Dr. Gerami: The influence of pregnancy on the prognosis of melanoma has been debated for decades. Even in the last ten years, population-based and cohort studies have given us mixed results, with some suggesting no adverse influence of pregnancy, and others reporting poorer outcomes and increased cause-specific mortality. The conflicting data leave many clinicians uncertain of how to advise patients to proceed with family planning after a diagnosis of melanoma. Since one-third of all new cases of melanoma diagnosed in women will occur during childbearing age, this represents a fairly common clinical dilemma for physicians and their patients.

We suspected that the different results from different investigators maybe related to the melanoma stage of the patients being studied. We investigated the impact of pregnancy on tumor proliferation in women with primarily early stage melanoma. In comparing melanomas from a group of women with pregnancy-associated melanoma (PAM) and a non-PAM group, we found that women with pregnancy-associated melanoma actually had a significantly greater proportion of in situ disease, and for cases of invasive melanoma there was no significant difference in proliferative activity, as assessed by mitotic count or two immunohistochemical markers of cell proliferation. In a comparison of additional prognostic features such as Breslow depth and ulceration, we found no significant differences between groups to suggest more aggressive tumor behavior in association with pregnancy.

Medical Research: What should clinicians and patients take away from your report?

Dr. Gerami: Most of the patients included in this study were followed regularly in our pigmented lesion clinic, and mostly had stage I melanoma. Our study indicates for this patient population, who are regularly screen and have early stage disease, that pregnancy does not significantly impact tumor proliferation or result in more aggressive tumor prognostic features. For similar patient populations with close clinical observation, early stage melanoma (stage 0 or 1) diagnosed during pregnancy or the first year postpartum should not outweigh traditional factors, such as advanced maternal age, in the planning of future pregnancies.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Gerami: We suspect that the influence of pregnancy on prognosis may vary by stage. Since our cohort is characterized by a predominance of Stage I disease, further studies are needed to assess the impact of pregnancy on melanoma tumors in more advanced stages.


A comparative study of proliferative activity and tumor stage of pregnancy-associated melanoma (PAM) and non-PAM in gestational age women

Merkel, Emily A. et al.

Journal of the American Academy of Dermatology

Pedram Gerami, MD (2015). Influence of Pregnancy on Melanoma May Vary By Stage