Confusion exists concerning the influence of pregnancy on survival in patients with malignant melanoma.
To evaluate this problem a retrospective computer-aided study was performed of women in the childbearing years treated for Stage I cutaneous melanoma at the Duke University Comprehensive Cancer Center. Fifty-eight women were identified who had melanoma arise during pregnancy (Group 1) and 43 patients were noted who became pregnant within 5 years of diagnosis of their melanoma (Group 2). Appropriate control groups matched for the clinical variables of age, primary site, and stage of disease and the pathologic variables of Clark's Level, tumor thickness, ulceration, and histologic type were selected from the cohort of 2938 melanoma patients seen at Duke. Actuarial survivals for Group 1 and 2 patients did not differ from their respective controls, although the small number of deaths in each group resulted in wide confidence intervals. When actuarial disease-free intervals were plotted, there was a significant difference beween women who had melanoma develop during pregnancy when compared to their controls (P = 0.04). In a multivariate regression analysis, after adjustment for the influence of the more significant prognostic factors for Stage 1 melanoma, including Clark's Level, ulceration, and tumor thickness, the effect of pregnancy on disease-free interval became more apparent (P = 0.02). No difference in actuarial disease-free interval was noted in the melanoma patients who elected to become pregnant within 5 years of diagnosis (P = 0.31). A multivariate regression analysis confirmed this finding. These data indicate that although an intercurrent melanoma during pregnancy has a worse prognosis than the control groups, once a woman has been diagnosed as having a cutaneous melanoma, a subsequent pregnancy has no effect on recurrence rate or survival.
Cancer 551340-1344, 1985.
HE EFFECTS of pregnancy or hormonal manipulation
T on the pathogenesis and metastatic spread of malignant melanoma is unclear. Although the tumor occurs in equal frequency in men and women, it has been noted that women present with an earlier stage of disease,' have more favorable primary sites,' and have longer survival times'.' than their male counterparts. These sex differences argue for a hormonal influence on this tumor. Animal studies have shown either no effect4 or a decreased survival536 when melanomas have been grown in female compared to male rodents or when exogenous hormone treatment has been evaluated in animal models.' Large-base clinical studies have also reported conflicting data. Pack and Scharnage18 and later Byrd and McGanty' suggested that malignant melanoma was particularly lethal when it arose during pregnancy and postulated that therapeutic abortions