Melanoma During Pregnancy

Abstract

Melanoma is the most malignant cutaneous tumor. The incidence of melanoma accounts for the sixth place among malignant diseases, 5% of malignancies among men and 4% of malignancies among women; it stands for 1.4% of deaths caused by malignant disease (Fisher et al., 2008). The incidence of malignant melanoma has constantly been increasing and it has reached 3% per year in the last several years. At the beginning of the 20th century, the population risk for malignant melanoma was in the ratio 1:500 but today 1:73 of women and 1:49 of men are at risk (Fisher et al., 2008). It is anticipated that there will be 68,130 newly diagnose cases of melanoma and approximately 8,700 deaths from the disease in the USA (Jamal et al., 2010). Among the population aged between 20 to 39 years malignant melanoma is on the second place by incidence. Although the disease is more frequent among men, its incidence during the reproductive period is higher among women. In Great Britain, the third of all diagnosed melanomas arise before 50 years of age and about 30% to 35% develop during the reproductive period of women (Anonymus, 2003; Cancer Research UK 2006). The actual incidence of melanoma during pregnancy is unknown. Smith and Randall (Smith RS & Randall, 1969) gave the first reports based on the source documents of a small non-reference Plattsburg Air Force Base Hospital, New York. The incidence of melanoma was 2.8 per 1000 deliveries but studies that are more recent showed that it is between 2.8 and 5 per 100,000 of pregnancies; the registry of German Dermatological Society shows that 1% of female patients affected with melanoma is pregnant (Dillman et al., 1996; Garbe, 1993). A group of Swedish authors analyzed the period from 1973 to 1984 and reported that melanoma is the most common cancer appearing in pregnancy and accounts for 24.5% of cancer cases in pregnant women (Matthiasen & Berg, 1989). From 1958 to 1999, 19,337 women with melanoma were included in the most extensive epidemiology study based on Swedish and regional registries; 0.9% of malignant melanomas were diagnosed during the pregnancy. Of all included patients, 5,533 of women were in reproductive age and 185 (3.3%) of them were diagnosed with melanoma during the pregnancy (Lens et al., 2004.). The prognostic features for melanoma depend on the stage it has been diagnosed. Although the 5-year survival for stage IV melanoma is still less than 5%, overall mortality from melanoma has a decreasing tendency (Rigel et al., 1996). The effect of pregnancy to the course of melanoma has been a researching issue for years. The results of uncontrolled studies conducted from 1950 to 1980 show that pregnancy is an unfavorable prognostic factor in