Melanoma and pregnancy: A 30-year experience at the Turin Melanoma Centre and a review of the literature data

Aim. The role of pregnancy in the prognosis of women affected by melanoma has been a controversial issue for many years, even if recent studies failed to document an adverse effect of pregnancy on melanoma outcome and underlined the primary role of Breslow thickness as prognostic factor. Methods. In this paper, we reviewed our database of 4 508 melanoma patients, diagnosed and followed-up prospectively from 1975 to 2005 at our institution, focusing on the impact of pregnancy on prognosis and on the management of melanoma in pregnancy. Among this population, 674 females of childbearing age were identified. Comparison of overall survival and disease-free survival between pregnant, nonpregnant and women with a pregnancy subsequent to the melanoma diagnosis was performed using the Kaplan-Meier product-limit method; multivariate analysis using the Cox proportional hazard regression model was also performed. Results. No statistically significant differences were found in the overall and disease free survival (DFS) comparing the 13 women that were diagnosed during pregnancy with nonpregnant women. Multivariate analysis of overall survival and DFS confirmed the role of Breslow thickness and ulceration as an independent adverse prognostic factor and excluded that pregnancy concomitant or subsequent to melanoma diagnosis can influence the clinical outcome. Conclusion. In our experience the prognosis of women diagnosed with melanoma during pregnancy does not differ from that of nonpregnant women, if adjusted for the known melanoma prognostic factors, mainly Breslow thickness and ulceration. Therefore, even during pregnancy, an early diagnosis is of overwhelming relevance for the survival and a suspicious pigmented lesion must be treated surgically without delay.