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Pelczar P, Kosteczko P, Wieczorek E, Kwieciński M, Kozłowska A, Gil-Kulik P. Melanoma in Pregnancy-Diagnosis, Treatment, and Consequences for Fetal Development and the Maintenance of Pregnancy. Cancers (Basel) 2024; 16:2173. [PMID: 38927879 PMCID: PMC11202133 DOI: 10.3390/cancers16122173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Cutaneous malignant melanoma is one of the most common neoplasms among pregnancy-associated cancers (PACs). Risk factors include excessive exposure to ultraviolet radiation, the presence of benign and dysplastic nevi, and a patient or family history of melanoma. Self-examination and careful inspection of nevi are crucial, especially in the context of their progression over time. Physiological changes that occur during pregnancy, such as the darkening and enlargement of the nevi, delay the diagnosis of CMM. In the fetus, metastases are very rare, and if they do occur, they concern the placenta or fetal tissues. The choice of treatment is influenced by the cancer stage, symptoms, the time of termination of pregnancy, and the patient's decision. Essential procedures which are safe for the fetus are diagnostic biopsy, ultrasound, and the therapeutic excision of the lesion and the affected lymph nodes. Other imaging methods can be used with a safe radiation dose limit of 100 mGy. Immunotherapy and targeted treatments must be carefully considered, because of their possible adverse effects on the fetus. An interdisciplinary approach to the problem of melanoma during pregnancy is necessary, involving doctors of various specialties.
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Affiliation(s)
- Patrycja Pelczar
- Student Scientific Society of Clinical Genetics, Medical University of Lublin, 11 Radziwillowska Str., 20-080 Lublin, Poland; (P.P.); (P.K.); (E.W.); (M.K.)
| | - Pola Kosteczko
- Student Scientific Society of Clinical Genetics, Medical University of Lublin, 11 Radziwillowska Str., 20-080 Lublin, Poland; (P.P.); (P.K.); (E.W.); (M.K.)
| | - Ewelina Wieczorek
- Student Scientific Society of Clinical Genetics, Medical University of Lublin, 11 Radziwillowska Str., 20-080 Lublin, Poland; (P.P.); (P.K.); (E.W.); (M.K.)
| | - Maciej Kwieciński
- Student Scientific Society of Clinical Genetics, Medical University of Lublin, 11 Radziwillowska Str., 20-080 Lublin, Poland; (P.P.); (P.K.); (E.W.); (M.K.)
| | - Aleksandra Kozłowska
- Department of Radiotherapy, Medical University of Lublin, 13 Radziwillowska Str., 20-080 Lublin, Poland;
| | - Paulina Gil-Kulik
- Department of Clinical Genetics, Medical University of Lublin, 11 Radziwillowska Str., 20-080 Lublin, Poland
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Lundberg FE, Stensheim H, Ullenhag GJ, Sahlgren H, Lindemann K, Fredriksson I, Johansson ALV. Risk factors for the increasing incidence of pregnancy-associated cancer in Sweden - a population-based study. Acta Obstet Gynecol Scand 2024; 103:669-683. [PMID: 37694965 PMCID: PMC10993331 DOI: 10.1111/aogs.14677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION The incidence of cancer during pregnancy and within first year post-delivery, ie pregnancy-associated cancer (PAC), is increasing in many countries, but little is known about risk factors for these trends. This study quantified incidence of PAC by trimesters and post-delivery periods, and assessed the role of maternal age, parity, immigrant status, education, smoking and body mass index for the risk and incidence trends of PAC. MATERIAL AND METHODS We used data from the national birth and cancer registers in Sweden during 1973-2017 to define a register-based cohort of women aged 15-44 years. Incidence rates of PAC during pregnancy and up to 1 year post-delivery were calculated per 100 000 deliveries per year. Poisson regression with multiple imputation estimated incidence rate ratios with 95% confidence intervals adjusted by year, age, previous parity, immigrant status, education, smoking and BMI during 1990-2017, when information on risk factors was available. RESULTS Among 4 557 284 deliveries, a total of 1274 (during pregnancy) and 3355 (within 1 year post-delivery) cases of PAC were diagnosed, with around 50 cases/year diagnosed during pregnancy and 110 cases/year during the first year post-delivery in the latest period 2015-2017. The most common cancer types during pregnancy were malignant melanoma, breast and cervical cancer, together accounting for 57% of cases during pregnancy and 53% during the first year post-delivery. The numbers of PAC were lower during pregnancy than during post-delivery for all tumor types with lowest numbers during first trimester. The PAC incidence rates increased over calendar time. High maternal age at diagnosis, smoking, nulliparity and non-immigrant background were associated with significantly higher risks of PAC. The increasing PAC incidence was in part explained by higher maternal age over time, but not by the other factors. CONCLUSIONS High maternal age is the strongest risk factor for PAC. We show for the first time that smoking, nulliparity and non-immigrant background are also contributing risk factors for PAC. However, only high maternal age contributed significantly to the increasing incidence. Further studies on other potential risk factors for PAC are warranted, since our results indicate that age on its own does not fully explain the increase.
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Affiliation(s)
- Frida E. Lundberg
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Department of Pathology‐OncologyKarolinska InstitutetStockholmSweden
| | | | - Gustav J. Ullenhag
- Department of OncologyUppsala University HospitalUppsalaSweden
- Department of Immunology, Genetics and PathologyUppsala UniversityUppsalaSweden
| | - Hanna Milerad Sahlgren
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Department of Obstetrics and GynecologyFalun HospitalFalunSweden
- Regional Cancer Center UppsalaUppsalaSweden
| | - Kristina Lindemann
- Department of Gynecological OncologyOslo University HospitalOsloNorway
- Faculty of Medicine, Institute of Clinical MedicineUniversity of OsloNorway
| | - Irma Fredriksson
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Breast, Endocrine Tumors and SarcomaKarolinska University HospitalStockholmSweden
| | - Anna L. V. Johansson
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Cancer Registry of NorwayOsloNorway
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Walters B, Midwinter I, Chew-Graham CA, Jordan KP, Sharma G, Chappell LC, Crosbie EJ, Parwani P, Mamas MA, Wu P. Pregnancy-Associated Cancer: A Systematic Review and Meta-Analysis. Mayo Clin Proc Innov Qual Outcomes 2024; 8:188-199. [PMID: 38524280 PMCID: PMC10957385 DOI: 10.1016/j.mayocpiqo.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
This study aimed to systematically evaluate and quantify the risk of adverse maternal and neonatal outcomes in patients with pregnancy-associated cancer (PAC). This study was conducted from February 13, 2021, through July 24, 2023. A systematic search of MEDLINE, Embase, Web of Science Core Collection, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials was conducted to identify studies reporting outcomes for patients with PAC. The study was registered on PROSPERO. Two reviewers independently conducted screening, data extraction, and quality assessment. The associations were quantified using random-effects meta-analysis. The initial search produced 29,401 titles and abstracts, after which 147 unique full-text articles were screened, of which 22 articles with 59,190 pregnancies with PAC from 70,097,167 births were included in the meta-analysis. Women with PAC were at significantly increased risk of cesarean deliveries (risk ratio [RR], 1.58; 95% CI, 1.31-1.89), preterm birth (RR, 3.07; 95% CI, 2.37-3.98), venous thromboembolism (RR, 6.76; 95% CI, 5.08-8.99), and maternal death (RR, 41.58; 95% CI, 20.38-84.83). The only outcome with reduced risk was instrumental mode of delivery (RR, 0.67; 95% CI, 0.52-0.87). Pregnancy-associated cancer increases risk of adverse outcomes, including a 7-fold risk of venous thromboembolism and a 42-fold risk of maternal death. Further research is required to better understand the mechanisms leading to these adverse outcomes, especially for women who are not diagnosed until the postpartum period. Affected women should have counseling regarding their increased risk of adverse outcomes.
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Affiliation(s)
- Ben Walters
- Academic Department of Obstetrics and Gynaecology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom
| | - India Midwinter
- Academic Department of Obstetrics and Gynaecology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom
| | - Carolyn A. Chew-Graham
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Kelvin P. Jordan
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Garima Sharma
- Division of Cardiology, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lucy C. Chappell
- School of Life Course Sciences, King’s College London, London, United Kingdom
| | - Emma J. Crosbie
- Department of Obstetrics and Gynaecology, St Mary’s Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA
| | - Mamas A. Mamas
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom
- Keele Cardiovascular Research Group, Centre for Prognosis Research, School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Pensée Wu
- Academic Department of Obstetrics and Gynaecology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom
- Keele Cardiovascular Research Group, Centre for Prognosis Research, School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom
- Department of Obstetrics and Gynecology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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4
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Xie F, Agrawal S, Johnson EF, Wieland CN, Davis DMR, Theiler RN, Lehman JS. Updates on the dermatopathology of pregnancy-associated skin conditions. Hum Pathol 2023; 140:173-195. [PMID: 37209919 DOI: 10.1016/j.humpath.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/15/2023] [Indexed: 05/22/2023]
Abstract
Pathologists provide valuable input in the dermatological care of pregnant patients in various contexts. This article provides dermatopathology updates on cutaneous changes associated with pregnancy, organized based on the following classification system: physiological skin changes in pregnancy, specific dermatoses of pregnancy, dermatoses modified in pregnancy, and skin neoplasms in pregnancy. Awareness of the impact of pregnancy on the skin by pathologists is important, as this is an opportunity to contribute to diagnostic precision in this patient population.
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Affiliation(s)
- Fangyi Xie
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Shruti Agrawal
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Emma F Johnson
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Carilyn N Wieland
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Dawn Marie R Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Regan N Theiler
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
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5
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Yamauchi T, Shangraw S, Zhai Z, Ravindran Menon D, Batta N, Dellavalle RP, Fujita M. Alcohol as a Non-UV Social-Environmental Risk Factor for Melanoma. Cancers (Basel) 2022; 14:5010. [PMID: 36291794 PMCID: PMC9599745 DOI: 10.3390/cancers14205010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 12/24/2022] Open
Abstract
Although cancer mortality has declined among the general population, the incidence of melanoma continues to rise. While identifying high-risk cohorts with genetic risk factors improves public health initiatives and clinical care management, recognizing modifiable risk factors such as social-environmental risk factors would also affect the methods of patient outreach and education. One major modifiable social-environmental risk factor associated with melanoma is ultraviolet (UV) radiation. However, not all forms of melanoma are correlated with sun exposure or occur in sun-exposed areas. Additionally, UV exposure is rarely associated with tumor progression. Another social-environmental factor, pregnancy, does not explain the sharply increased incidence of melanoma. Recent studies have demonstrated that alcohol consumption is positively linked with an increased risk of cancers, including melanoma. This perspective review paper summarizes epidemiological data correlating melanoma incidence with alcohol consumption, describes the biochemical mechanisms of ethanol metabolism, and discusses how ethanol and ethanol metabolites contribute to human cancer, including melanoma.
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Affiliation(s)
- Takeshi Yamauchi
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Sarah Shangraw
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Zili Zhai
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Dinoop Ravindran Menon
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Nisha Batta
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Department of Veterans Affairs Medical Center, VA Eastern Colorado Health Care System, Aurora, CO 80045, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Mayumi Fujita
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Department of Veterans Affairs Medical Center, VA Eastern Colorado Health Care System, Aurora, CO 80045, USA
- Department of Immunology and Microbiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
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6
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Carter TJ, George C, Harwood C, Nathan P. Melanoma in pregnancy: Diagnosis and management in early-stage and advanced disease. Eur J Cancer 2022; 166:240-253. [PMID: 35325701 DOI: 10.1016/j.ejca.2022.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/30/2022] [Accepted: 02/18/2022] [Indexed: 12/13/2022]
Abstract
Approximately one-third of women diagnosed with melanoma are of child-bearing age. The annual incidence of melanoma has risen steadily over the last 40 years, resulting in increasing numbers of women diagnosed with melanoma both during pregnancy, and post-partum. To date, there are no formal guidelines on the management of pregnancy associated melanoma (PAM), both early stage and metastatic. This article reviews the existing literature and provides a framework for the investigation and multidisciplinary management of PAM.
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Affiliation(s)
- Thomas J Carter
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex, UK
| | - Christina George
- Department of Dermatology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Catherine Harwood
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK
| | - Paul Nathan
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex, UK.
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7
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Aguirre-Portolés C, Payne R, Trautz A, Foskett JK, Natale CA, Seykora JT, Ridky TW. ZIP9 Is a Druggable Determinant of Sex Differences in Melanoma. Cancer Res 2021; 81:5991-6003. [PMID: 34706862 DOI: 10.1158/0008-5472.can-21-0982] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/03/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022]
Abstract
Melanoma and most other cancers occur more frequently and have worse prognosis in males compared with females. Although sex steroids are thought to be involved, classical androgen and estrogen receptors are not detectable in most melanomas. Here we show that testosterone promotes melanoma proliferation by activating ZIP9 (SLC39A9), a zinc transporter that is widely expressed in human melanoma but not intentionally targeted by available therapeutics. This testosterone activity required an influx of zinc, activation of MAPK, and nuclear translocation of YAP. FDA-approved inhibitors of the classical androgen receptor also inhibited ZIP9, thereby antagonizing the protumorigenic effects of testosterone in melanoma. In male mice, androgen receptor inhibitors suppressed growth of ZIP9-expressing melanomas but had no effect on isogenic melanomas lacking ZIP9 or on melanomas in females. These data suggest that ZIP9 might be effectively targeted in melanoma and other cancers by repurposing androgen receptor inhibitors that are currently approved only for prostate cancer. SIGNIFICANCE: Testosterone signaling through ZIP9 mediates some of the sex differences in melanoma, and drugs that target AR can be repurposed to block ZIP9 and inhibit melanoma in males.
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Affiliation(s)
- Cristina Aguirre-Portolés
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Riley Payne
- Department of Physiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aspen Trautz
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - J Kevin Foskett
- Department of Physiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher A Natale
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John T Seykora
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Todd W Ridky
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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8
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Romanelli MR, Mansour A, Topaz A, Olla D, Neumeister MW. Melanoma in Pregnancy and Pediatrics. Clin Plast Surg 2021; 48:699-705. [PMID: 34503730 DOI: 10.1016/j.cps.2021.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Rare variants of melanoma include melanoma in pregnancy and pediatric melanoma. Because of their low incidence, treatment recommendations are based on standards of treatment for cutaneous melanoma; however, each of these forms requires specific considerations during diagnosis, staging, and treatment.
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Affiliation(s)
- Michael R Romanelli
- Institute for Plastic Surgery, Southern Illinois University, 747 North Rutledge Street #3, Springfield, IL 62702, USA
| | - Alaa Mansour
- Southern Illinois University School of Medicine, 747 North Rutledge Street #3, Springfield, IL 62702, USA
| | - Allyne Topaz
- Institute for Plastic Surgery, Southern Illinois University, 747 North Rutledge Street #3, Springfield, IL 62702, USA
| | - Danielle Olla
- Institute for Plastic Surgery, Southern Illinois University, 747 North Rutledge Street #3, Springfield, IL 62702, USA.
| | - Michael W Neumeister
- Department of Surgery, Institute for Plastic Surgery, Southern Illinois University, 747 North Rutledge Street #3, Springfield, IL 62702, USA
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9
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Benna C, Rajendran S, Spiro G, Menin C, Dall'Olmo L, Rossi CR, Mocellin S. Gender-specific associations between polymorphisms of the circadian gene RORA and cutaneous melanoma susceptibility. J Transl Med 2021; 19:57. [PMID: 33549124 PMCID: PMC7866430 DOI: 10.1186/s12967-021-02725-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/28/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Melanoma is the deadliest of skin cancers and has an increasing annual incidence worldwide. It is a multi-factorial disease most likely arising from both genetic predisposition and environmental exposure to ultraviolet light. Genetic variability of the components of the biological circadian clock is recognized to be a risk factor for different type of cancers. Moreover, two variants of a clock gene, RORA, have been associated with melanoma patient's prognosis. Our aim is to test the hypothesis that specific single nucleotide polymorphisms (SNPs) of the circadian clock genes may significantly influence the predisposition to develop cutaneous melanoma or the outcome of melanoma patients. METHODS We genotyped 1239 subjects, 629 cases of melanoma and 610 healthy controls in 14 known SNPs of seven selected clock genes: AANAT, CLOCK, NPAS2, PER1, PER2, RORA, and TIMELESS. Genotyping was conducted by q-PCR. Multivariate logistic regression was employed for susceptibility of melanoma assessment, modeled additively. Subgroup analysis was performed by gender. For the female subgroup, a further discrimination was performed by age. For prognosis of melanoma assessment, multivariate Cox proportional hazard regression was employed. The Benjamini-Hochberg method was utilized as adjustment for multiple comparisons. RESULTS We identified two RORA SNPs statistically significant with respect to the association with melanoma susceptibility. Considering the putative role of RORA as a nuclear steroid hormone receptor, we conducted a subgroup analysis by gender. Interestingly, the RORA rs339972 C allele was associated with a decreased predisposition to develop melanoma only in the female subgroup (OR 0.67; 95% CI 0.51-0.88; P = 0.003) while RORA rs10519097 T allele was associated with a decreased predisposition to develop melanoma only in the male subgroup (OR 0.62; 95% CI 0.44-0.87; P = 0.005). Moreover, the RORA rs339972 C allele had a decreased susceptibility to develop melanoma only in females aged over 50 years old (OR 0.67; 95% CI 0.54-0.83; P = 0.0002). None of the studied SNPs were significantly associated with the prognosis. CONCLUSIONS Overall, we cannot ascertain that circadian pathway genetic variation is involved in melanoma susceptibility or prognosis. Nevertheless, we identified an interesting relationship between melanoma susceptibility and RORA polymorphisms acting in sex-specific manner and which is worth further future investigation.
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Affiliation(s)
- Clara Benna
- Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy. .,First Surgical Clinic, Azienda Ospedaliera Padova, Padova, Italy.
| | - Senthilkumar Rajendran
- Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Giovanna Spiro
- Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Chiara Menin
- Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology (IOV - IRCCS), Padova, Italy
| | - Luigi Dall'Olmo
- Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy.,Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy
| | - Carlo Riccardo Rossi
- Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy.,Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy
| | - Simone Mocellin
- Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy.,Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy
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10
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Zelin E, Conforti C, Giuffrida R, Deinlein T, di Meo N, Zalaudek I. Melanoma in pregnancy: certainties unborn. Melanoma Manag 2020; 7:MMT48. [PMID: 32922730 PMCID: PMC7475795 DOI: 10.2217/mmt-2020-0007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 06/15/2020] [Indexed: 12/20/2022] Open
Abstract
Melanoma diagnosed during childbearing period or up to 1 year after delivery is defined as pregnancy-associated melanoma (PAM). There is some evidence that PAM has worse prognosis if compared with melanoma in nonpregnant women, although literature is still inconclusive. Many biological mechanisms could explain this behavior, such as hormonal and immune status, increased lymphangiogenesis but also delay in diagnostic and therapeutic management. If PAM is suspected, a prompt excisional biopsy under local anesthesia can be performed regardless of the gestational period. Conversely, additional staging procedures (such as sentinel lymph node biopsy or imaging) and systemic therapy are still debatable during pregnancy. A multidisciplinary tailored approach should be preferred, together with exhaustive counseling of the mother.
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Affiliation(s)
- Enrico Zelin
- Dermatology & Venereology Department, Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Claudio Conforti
- Dermatology & Venereology Department, Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Roberta Giuffrida
- Department of Clinical & Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Teresa Deinlein
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Nicola di Meo
- Dermatology & Venereology Department, Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Iris Zalaudek
- Dermatology & Venereology Department, Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
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11
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Frequency of Pregnancy-Associated Cancer: A Systematic Review of Population-Based Studies. Cancers (Basel) 2020; 12:cancers12061356. [PMID: 32466494 PMCID: PMC7352408 DOI: 10.3390/cancers12061356] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 12/20/2022] Open
Abstract
Despite numerous available resources of evidence, the results about the frequency of pregnancy-associated cancer (PAC) still show poor comparability due to dissimilarities in the study design and methodology, inclusion criteria, incoherent duration of follow-up and a heterogeneous reference population. We conducted a systematic review of population-based studies on PAC published up to December 2019, to provide updated research on this topic, highlighting strengths and limitations. Of the 24 papers included, 11 considered all types of tumors and 13 dealt with specific types of cancer. Differences in the procedures for estimating the frequency of PAC emerged even among population studies. However, we found consistent results for overall frequency of PAC— around 1/1000 pregnancies. Our review suggests that about 25% of PAC cases are diagnosed during pregnancy, confirming the hypothesis of an excess of diagnosis in the postpregnancy period. Sparse and inconsistent results were found regarding a potential increase in the frequency of PAC over calendar years. Alignments in the strategy to identify PAC are needed to overcome methodological weaknesses.
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12
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Li JN, Nijhawan RI, Srivastava D. Cutaneous Surgery in Patients Who Are Pregnant or Breastfeeding. Dermatol Clin 2019; 37:307-317. [PMID: 31084725 DOI: 10.1016/j.det.2019.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Dermatologic surgery in pregnant/postpartum patients requires deliberate consideration. Although surgery can be safely performed during any trimester, the second trimester and immediate postpartum period is optimal. Surgery should not be delayed for melanoma/high-risk skin cancers. Perioperative positioning, analgesic, antiseptic, and antibiotic selection should be deliberate to avoid risk to the patient/fetus/infant. The left lateral tilt position reduces aortocaval compression syndrome. Lidocaine and epinephrine can be used safely. Alcohol and chlorhexidine are considered safe. Antibiotics commonly used in skin surgery are safe in pregnancy and lactation. Acetaminophen is first line for pain management. Nonsteroidal antiinflammatory drugs should be avoided.
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Affiliation(s)
- Jeffrey N Li
- Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, 5939 Harry Hines Boulevard, Professional Office Building 2, Suite 400, Dallas, TX 75390, USA
| | - Divya Srivastava
- Department of Dermatology, University of Texas Southwestern Medical Center, 5939 Harry Hines Boulevard, Professional Office Building 2, Suite 400, Dallas, TX 75390, USA.
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13
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Maggen C, van Gerwen M, Van Calsteren K, Vandenbroucke T, Amant F. Management of cancer during pregnancy and current evidence of obstetric, neonatal and pediatric outcome: a review article. Int J Gynecol Cancer 2019; 29:ijgc-2018-000061. [PMID: 30659032 DOI: 10.1136/ijgc-2018-000061] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 12/28/2022] Open
Abstract
The diagnosis of cancer during pregnancy imposes a medical-ethical dilemma in weighing the risks of both mother and child. Increasing awareness of the feasibility of chemotherapy during pregnancy results in more pregnant patients receiving treatment for cancer. Information on obstetric and pediatric outcome of these high-risk pregnancies is greatly needed to guide physicians in patient counseling. In this review we present reported evidence for the incidence, diagnostic options, therapeutic management, obstetric risks, and neonatal outcome when cancer treatment is initiated during pregnancy. Decision-making when a cancer is diagnosed in a pregnant patient should be multidisciplinary, always taking the patient's perspective into account. Cancer treatment during pregnancy is associated with low birth weight and preterm delivery, therefore frequent obstetric follow-up during oncological treatment in a specialized center is mandatory. Short-term clinical, cardiac, and cognitive outcome of children pre-natally exposed to cancer treatment is overall reassuring. Long-term follow-up of children is warranted to define the possible effect of pre-natal cancer treatment on general health, fertility outcome, and the risk of secondary cancers.
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Affiliation(s)
- Charlotte Maggen
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - Mathilde van Gerwen
- Center for Gynecological Oncology Amsterdam, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Kristel Van Calsteren
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Tineke Vandenbroucke
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - Frédéric Amant
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, KU Leuven, Leuven, Belgium
- Center for Gynecological Oncology Amsterdam, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
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14
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Li B, Wang Y, Xu Y, Liu H, Bloomer W, Zhu D, Amos CI, Fang S, Lee JE, Li X, Han J, Wei Q. Genetic variants in RORA and DNMT1 associated with cutaneous melanoma survival. Int J Cancer 2018; 142:2303-2312. [PMID: 29313974 PMCID: PMC5893376 DOI: 10.1002/ijc.31243] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 11/30/2017] [Accepted: 12/05/2017] [Indexed: 02/06/2023]
Abstract
Cutaneous melanoma (CM) is considered as a steroid hormone-related malignancy. However, few studies have evaluated the roles of genetic variants encoding steroid hormone receptor genes and their related regulators (SHR-related genes) in CM-specific survival (CMSS). Here, we performed a pathway-based analysis to evaluate genetic variants of 191 SHR-related genes in 858 CMSS patients using a dataset from a genome-wide association study (GWAS) from The University of Texas MD Anderson Cancer Center (MDACC), and then validated the results in an additional dataset of 409 patients from the Harvard GWAS. Using multivariate Cox proportional hazards regression analysis, we identified three-independent SNPs (RORA rs782917 G > A, RORA rs17204952 C > T and DNMT1 rs7253062 G > A) as predictors of CMSS, with a variant-allele attributed hazards ratio (HR) and 95% confidence interval of 1.62 (1.25-2.09), 1.60 (1.20-2.13) and 1.52 (1.20-1.94), respectively. Combined analysis of risk genotypes of these three SNPs revealed a decreased CMSS in a dose-response manner as the number of risk genotypes increased (ptrend < 0.001); however, no improvement in the prediction model was observed (area under the curve [AUC] = 79.6-80.8%, p = 0.656), when these risk genotypes were added to the model containing clinical variables. Our findings suggest that genetic variants of RORA and DNMT1 may be promising biomarkers for CMSS, but these results needed to be validated in future larger studies.
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Affiliation(s)
- Bo Li
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, PR China
| | - Yanru Wang
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - Yinghui Xu
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin 130021, PR China
| | - Hongliang Liu
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - Wendy Bloomer
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - Dakai Zhu
- Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Christopher I. Amos
- Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Shenying Fang
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Jeffrey E. Lee
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Xin Li
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Jiali Han
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Qingyi Wei
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27710, USA
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15
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Natale CA, Li J, Zhang J, Dahal A, Dentchev T, Stanger BZ, Ridky TW. Activation of G protein-coupled estrogen receptor signaling inhibits melanoma and improves response to immune checkpoint blockade. eLife 2018; 7. [PMID: 29336307 PMCID: PMC5770157 DOI: 10.7554/elife.31770] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/05/2017] [Indexed: 12/30/2022] Open
Abstract
Female sex and history of prior pregnancies are associated with favorable melanoma outcomes. Here, we show that much of the melanoma protective effect likely results from estrogen signaling through the G protein-coupled estrogen receptor (GPER) on melanocytes. Selective GPER activation in primary melanocytes and melanoma cells induced long-term changes that maintained a more differentiated cell state as defined by increased expression of well-established melanocyte differentiation antigens, increased pigment production, decreased proliferative capacity, and decreased expression of the oncodriver and stem cell marker c-Myc. GPER signaling also rendered melanoma cells more vulnerable to immunotherapy. Systemically delivered GPER agonist was well tolerated, and cooperated with immune checkpoint blockade in melanoma-bearing mice to dramatically extend survival, with up to half of mice clearing their tumor. Complete responses were associated with immune memory that protected against tumor rechallenge. GPER may be a useful, pharmacologically accessible target for melanoma.
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Affiliation(s)
- Christopher A Natale
- Perelman School of Medicine, Department of Dermatology, University of Pennsylvania, Philadelphia, United States
| | - Jinyang Li
- Abramson Family Cancer Research Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States
| | - Junqian Zhang
- Perelman School of Medicine, Department of Dermatology, University of Pennsylvania, Philadelphia, United States
| | - Ankit Dahal
- Perelman School of Medicine, Department of Dermatology, University of Pennsylvania, Philadelphia, United States
| | - Tzvete Dentchev
- Perelman School of Medicine, Department of Dermatology, University of Pennsylvania, Philadelphia, United States
| | - Ben Z Stanger
- Abramson Family Cancer Research Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States
| | - Todd W Ridky
- Perelman School of Medicine, Department of Dermatology, University of Pennsylvania, Philadelphia, United States
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16
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Mendizábal E, De León-Luis J, Gómez-Hidalgo NR, Joigneau L, Pintado P, Rincón P, Ortega V, Lizarraga S. Maternal and perinatal outcomes in pregnancy-associated melanoma. Report of two cases and a systematic literature review. Eur J Obstet Gynecol Reprod Biol 2017; 214:131-139. [DOI: 10.1016/j.ejogrb.2017.04.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 04/01/2017] [Accepted: 04/09/2017] [Indexed: 10/19/2022]
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17
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Lu D, Ludvigsson JF, Smedby KE, Fall K, Valdimarsdóttir U, Cnattingius S, Fang F. Maternal Cancer During Pregnancy and Risks of Stillbirth and Infant Mortality. J Clin Oncol 2017; 35:1522-1529. [DOI: 10.1200/jco.2016.69.9439] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To examine whether maternal cancer during pregnancy is associated with increased risks of stillbirth and infant mortality. Methods On the basis of nationwide health registers, we conducted a study of 3,947,215 singleton births in Sweden from 1973 through 2012. Exposure was defined as maternal cancer diagnosed during pregnancy (number of births = 984) or during the year after pregnancy (number of births = 2,723). We calculated incidence rate ratios (IRRs) for stillbirth and infant mortality, comparing exposed births to unexposed births. Small-for-gestational-age (SGA) and preterm births were examined as secondary outcomes. Results Maternal cancer diagnosed during pregnancy was positively associated with stillbirth (IRR, 2.5; 95% CI, 1.2 to 5.0), mainly stillbirths assessed as SGA (IRR, 4.9; 95% CI, 2.2 to 11.0), and with preterm SGA births (relative risk 3.0; 95% CI, 2.1 to 4.4). Positive associations of maternal cancer diagnosed during pregnancy or the year after pregnancy were noted for both neonatal mortality (deaths within 0 to 27 days; IRR, 2.7; 95% CI, 1.3 to 5.6 and IRR, 2.0; 95% CI, 1.2 to 3.2, respectively) and preterm birth (IRR, 5.8; 95% CI, 5.3 to 6.5 and IRR, 1.6; 95% CI, 1.4 to 1.8, respectively). The positive association with preterm birth was due to iatrogenic instead of spontaneous preterm birth. Preterm birth explained 89% of the association of maternal cancer during pregnancy with neonatal mortality. Conclusion Maternal cancer during pregnancy is associated with increased risks of rare but fatal outcomes, including stillbirth and neonatal mortality. This may be due to conditions associated with fetal growth restriction and iatrogenic preterm birth. Careful monitoring of fetal growth and cautious decision making on preterm delivery should therefore be reinforced.
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Affiliation(s)
- Donghao Lu
- Donghao Lu, Jonas F. Ludvigsson, Katja Fall, Unnur Valdimarsdóttir, and Fang Fang, Karolinska Institutet; Karin E. Smedby and Sven Cnattingius, Karolinska University Hospital, Stockholm; Jonas F. Ludvigsson, Örebro University Hospital; Katja Fall, Örebro University, Örebro, Sweden; Jonas F. Ludvigsson, University of Nottingham, Nottingham, United Kingdom; Jonas F. Ludvigsson, Columbia University College of Physicians and Surgeons, New York, NY; and Unnur Valdimarsdóttir, University of Iceland, Reykjavík,
| | - Jonas F. Ludvigsson
- Donghao Lu, Jonas F. Ludvigsson, Katja Fall, Unnur Valdimarsdóttir, and Fang Fang, Karolinska Institutet; Karin E. Smedby and Sven Cnattingius, Karolinska University Hospital, Stockholm; Jonas F. Ludvigsson, Örebro University Hospital; Katja Fall, Örebro University, Örebro, Sweden; Jonas F. Ludvigsson, University of Nottingham, Nottingham, United Kingdom; Jonas F. Ludvigsson, Columbia University College of Physicians and Surgeons, New York, NY; and Unnur Valdimarsdóttir, University of Iceland, Reykjavík,
| | - Karin E. Smedby
- Donghao Lu, Jonas F. Ludvigsson, Katja Fall, Unnur Valdimarsdóttir, and Fang Fang, Karolinska Institutet; Karin E. Smedby and Sven Cnattingius, Karolinska University Hospital, Stockholm; Jonas F. Ludvigsson, Örebro University Hospital; Katja Fall, Örebro University, Örebro, Sweden; Jonas F. Ludvigsson, University of Nottingham, Nottingham, United Kingdom; Jonas F. Ludvigsson, Columbia University College of Physicians and Surgeons, New York, NY; and Unnur Valdimarsdóttir, University of Iceland, Reykjavík,
| | - Katja Fall
- Donghao Lu, Jonas F. Ludvigsson, Katja Fall, Unnur Valdimarsdóttir, and Fang Fang, Karolinska Institutet; Karin E. Smedby and Sven Cnattingius, Karolinska University Hospital, Stockholm; Jonas F. Ludvigsson, Örebro University Hospital; Katja Fall, Örebro University, Örebro, Sweden; Jonas F. Ludvigsson, University of Nottingham, Nottingham, United Kingdom; Jonas F. Ludvigsson, Columbia University College of Physicians and Surgeons, New York, NY; and Unnur Valdimarsdóttir, University of Iceland, Reykjavík,
| | - Unnur Valdimarsdóttir
- Donghao Lu, Jonas F. Ludvigsson, Katja Fall, Unnur Valdimarsdóttir, and Fang Fang, Karolinska Institutet; Karin E. Smedby and Sven Cnattingius, Karolinska University Hospital, Stockholm; Jonas F. Ludvigsson, Örebro University Hospital; Katja Fall, Örebro University, Örebro, Sweden; Jonas F. Ludvigsson, University of Nottingham, Nottingham, United Kingdom; Jonas F. Ludvigsson, Columbia University College of Physicians and Surgeons, New York, NY; and Unnur Valdimarsdóttir, University of Iceland, Reykjavík,
| | - Sven Cnattingius
- Donghao Lu, Jonas F. Ludvigsson, Katja Fall, Unnur Valdimarsdóttir, and Fang Fang, Karolinska Institutet; Karin E. Smedby and Sven Cnattingius, Karolinska University Hospital, Stockholm; Jonas F. Ludvigsson, Örebro University Hospital; Katja Fall, Örebro University, Örebro, Sweden; Jonas F. Ludvigsson, University of Nottingham, Nottingham, United Kingdom; Jonas F. Ludvigsson, Columbia University College of Physicians and Surgeons, New York, NY; and Unnur Valdimarsdóttir, University of Iceland, Reykjavík,
| | - Fang Fang
- Donghao Lu, Jonas F. Ludvigsson, Katja Fall, Unnur Valdimarsdóttir, and Fang Fang, Karolinska Institutet; Karin E. Smedby and Sven Cnattingius, Karolinska University Hospital, Stockholm; Jonas F. Ludvigsson, Örebro University Hospital; Katja Fall, Örebro University, Örebro, Sweden; Jonas F. Ludvigsson, University of Nottingham, Nottingham, United Kingdom; Jonas F. Ludvigsson, Columbia University College of Physicians and Surgeons, New York, NY; and Unnur Valdimarsdóttir, University of Iceland, Reykjavík,
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18
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Is Pregnancy-Associated Melanoma Associated with Adverse Outcomes? J Am Coll Surg 2017; 225:149-158. [PMID: 28457692 DOI: 10.1016/j.jamcollsurg.2017.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/10/2017] [Accepted: 02/13/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Melanoma is the most common malignancy encountered during pregnancy. Conflicting data have led to ongoing confusion regarding pregnancy-associated melanoma (PAM) in the media and among the public. The objective of this study was to better characterize both the clinical presentation of PAM and its prognostic implications. STUDY DESIGN Female patients of reproductive age, with stage 0 to IV cutaneous melanoma, were identified from our prospectively maintained database. Clinical and histopathologic factors were analyzed with appropriate statistical methods. Univariable and then multivariable analysis were used on matched data to compare disease-free survival (DFS), overall survival (OS), and melanoma-specific survival (MSS) for stage 0-III PAMs vs non-PAMs. Kaplan-Meier survival curves were then plotted for OS and MSS and compared using the log-rank test. RESULTS The clinical presentation of melanoma was similar for PAM and non-PAM patients. There was no significant difference in recurrence between the 2 groups; for PAM patients, 38.5% of patients had recurrence, as compared with 36.6% of non-PAM patients (p = 0.641). For PAM patients, median follow-up was 14.6 years (range 0 to 42.6 years) and 11.1 years (0 to 48.5 years) for the non-PAM patients. No significant differences in DFS, MSS, or OS were identified on univariable or multivariable analysis for PAM vs non-PAM patients in stage 0/I/II and stage III cutaneous melanoma, respectively (p = 0.880 DFS, p = 0.219 OS, and p = 0.670 MSS). CONCLUSIONS We observed no difference in DFS, OS, or MSS between the 2 groups. Pregnant patients should be screened for melanoma in a similar manner to nonpregnant patients and should be counseled that their survival is not adversely affected by their pregnancy.
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19
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Still R, Brennecke S. Melanoma in pregnancy. Obstet Med 2017; 10:107-112. [PMID: 29051777 DOI: 10.1177/1753495x17695001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 01/16/2017] [Indexed: 11/16/2022] Open
Abstract
Melanoma is one of the most common cancers diagnosed in pregnancy and has a high metastatic potential. As the incidence of melanoma increases, careful clinical evaluation of suspicious skin lesions remains the mainstay of early diagnosis. There is controversy in the literature as to whether pregnancy-associated melanoma has worse survival than other melanomas. Any changing-pigmented lesion should be biopsied, regardless of pregnancy hyperpigmentation. Increased lymphangiogenesis in pregnancy is associated with increased metastasis - timely diagnosis is therefore imperative. While the effect of oestrogen and progesterone on melanoma is under investigation, it is generally accepted that oral contraceptive use in not contraindicated after a diagnosis of melanoma in pregnancy. Subsequent pregnancy should be delayed for two to three years after a diagnosis of melanoma with a high risk of recurrence.
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Affiliation(s)
| | - Shaun Brennecke
- Department of Maternal-Fetal Medicine, Royal Women's Hospital, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
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20
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Morton SK, Morton AP. Melanoma and pregnancy. Australas J Dermatol 2017; 58:259-267. [PMID: 28185271 DOI: 10.1111/ajd.12568] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 08/15/2016] [Indexed: 12/28/2022]
Abstract
Melanoma is the most common cancer in women during their reproductive years and kills more young Australians than any other single cancer. Care of women whose pregnancy is complicated by a diagnosis of malignancy is complex. The risk of delaying treatment to the mother, the short-term and long-term risks of premature delivery to the child, and the immediate risks to the foetus and long-term risks to the child of maternal treatment with surgery, radiotherapy or medical therapies must be considered.
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Affiliation(s)
- Sarah Kym Morton
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Adam Park Morton
- Department of Obstetric Medicine, Mater Health Services, Brisbane, Queensland, Australia
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21
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Khosrotehrani K, Olsen CM, Byrom L, Green AC. Melanoma during pregnancy: Level of evidence and principles of precaution. J Am Acad Dermatol 2016; 76:e29-e30. [PMID: 27986158 DOI: 10.1016/j.jaad.2016.08.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 08/19/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Kiarash Khosrotehrani
- Diamantina Institute, Translational Research Institute, University of Queensland, Brisbane, Australia; Center for Clinical Research, Experimental Dermatology Group, University of Queensland, Brisbane, Australia; Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia.
| | - Catherine M Olsen
- School of Public Health, University of Queensland, Brisbane, Australia; QIMR (Queensland Institute of Medical Research) Berghofer Medical Research Institute, Brisbane, Australia
| | - Lisa Byrom
- Diamantina Institute, Translational Research Institute, University of Queensland, Brisbane, Australia
| | - Adele C Green
- QIMR (Queensland Institute of Medical Research) Berghofer Medical Research Institute, Brisbane, Australia; CRUK (Cancer Research United-Kingdom) Manchester Institute and Institute of Inflammation and Repair, University of Manchester, Manchester, United Kingdom
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22
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Ribero S, Longo C, Dika E, Fortes C, Pasquali S, Nagore E, Glass D, Robert C, Eggermont AM, Testori A, Quaglino P, Nathan P, Argenziano G, Puig S, Bataille V. Pregnancy and melanoma: a European-wide survey to assess current management and a critical literature overview. J Eur Acad Dermatol Venereol 2016; 31:65-69. [PMID: 27231086 DOI: 10.1111/jdv.13722] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/18/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Management of melanoma during pregnancy can be extremely challenging. The reported incidence of melanoma in pregnancy ranges from 2.8 to 5.0 per 100 000 pregnancies. There are no guidelines for the management of melanoma during pregnancy. METHODS The survey was designed to investigate the opinions of melanoma physicians on decision making in relation to pregnancy and melanoma. A clinical scenario-based survey on management of pregnancy in melanoma was distributed all over Europe via the membership of the EORTC and other European melanoma societies. RESULTS A total of 290 questionnaires were returned with a larger participation from southern Europe. A large heterogeneity was found for the answers given in the different clinical scenarios with 50% of the answers showing discordance, especially regarding sentinel lymph node biopsy during pregnancy. Discordant answers were also found for the counselling of women about a potential delay in getting pregnant after a high-risk melanoma (35% for a 2 year wait minimum vs. 57% no waiting needed), while for thin melanomas, as expected, there was more concordance with 70% of the physicians recommending no delay. Fifteen per cent of physicians recommended an abortion in stage II melanoma during the third month of pregnancy. Twenty per cent of the responders advised against hormonal replacement therapy in melanoma patients. CONCLUSIONS The management of melanoma during pregnancy varies widely in Europe. At present, there is a lack of consensus in Europe, which may lead to very important decisions in women with melanoma, and guidelines are needed.
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Affiliation(s)
- S Ribero
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - C Longo
- Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy
| | - E Dika
- Dermatology Department, University of Bologna, Bologna, Italy
| | - C Fortes
- Clinical Epidemiology Unit, IDI-IRCSS-FLMM Rome, Rome, Italy
| | - S Pasquali
- Surgical Oncology, Veneto Institute of Oncology - IRCCS, Padova, Italy
| | - E Nagore
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain
| | - D Glass
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - C Robert
- Institut de Cancérologie, Institut Gustave Roussy, Villejuif, France
| | - A M Eggermont
- Institut de Cancérologie, Institut Gustave Roussy, Villejuif, France
| | - A Testori
- European Institute of Oncology, Milan, Italy
| | - P Quaglino
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - P Nathan
- Mount Vernon Cancer Center, Northwood, UK
| | - G Argenziano
- Dermatology Department, Federico II University of Naples, Naples, Italy
| | - S Puig
- Melanoma Unit, Dermatology Department Hospital Clinic and University of Barcelona, CIBER de Enfermedades Raras, Barcelona, Spain
| | - V Bataille
- Dermatology Department, West Herts NHS Trust, Herts, UK
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23
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Merkel EA, Martini MC, Amin SM, Yélamos O, Lee CY, Sholl LM, Rademaker AW, Guitart J, Gerami P. A comparative study of proliferative activity and tumor stage of pregnancy-associated melanoma (PAM) and non-PAM in gestational age women. J Am Acad Dermatol 2016; 74:88-93. [PMID: 26545488 DOI: 10.1016/j.jaad.2015.09.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/04/2015] [Accepted: 09/12/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND The influence of pregnancy on the development, progression, and prognosis of melanoma is controversial. OBJECTIVE We sought to compare clinical characteristics, histologic features, and proliferative activity in pregnancy-associated melanoma (PAM) and melanoma in nonpregnant women of reproductive age (non-PAM). METHODS In this retrospective cohort study, we reviewed medical records and pathology reports from women given a diagnosis of melanoma between 2006 and 2015. We also examined tumor proliferation rates using mitotic count and 2 immunohistochemical markers of proliferation, phosphohistone H3 and Ki-67. RESULTS In 50 PAM and 122 non-PAM cases, a diagnosis of melanoma in situ was associated with PAM. Among invasive melanomas, there was no difference in proliferative activity between groups. Pregnancy status was also not associated with age at diagnosis, tumor site, Breslow depth, Clark level, ulceration, or overall stage. LIMITATIONS This was a retrospective study with a small sample size of mostly patients with early-stage melanoma. CONCLUSIONS In our study of primarily early-stage melanoma, pregnancy did not have a significant impact on tumor proliferation. Particularly for patients given a diagnosis of stage I melanoma who are undergoing close surveillance, a history of PAM should not outweigh traditional factors, such as advanced maternal age, in planning future pregnancies.
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Affiliation(s)
- Emily A Merkel
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mary C Martini
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sapna M Amin
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Oriol Yélamos
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Christina Y Lee
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lauren M Sholl
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alfred W Rademaker
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joan Guitart
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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