Mortality in women with pregnancy-associated malignant melanoma

Published:October 15, 2014DOI:


      Malignant melanoma (MM) is one of the most common malignancies in young women. It remains debated whether a MM diagnosed during pregnancy or lactation has a worse prognosis.


      We sought to examine mortality in women with pregnancy-associated MM (PAMM) (diagnosed during pregnancy and up to 2-years postpartum).


      This was a population-based cohort study based on information retrieved from the Swedish Cancer and Multi-Generation Registers. Hazard ratios with 95% confidence intervals adjusted for age, period, education, parity, and tumor location were estimated.


      In total, 6857 women and girls aged 15 to 44 years with a diagnosis of cutaneous MM between 1963 and 2009 were identified. Of these, 1019 cases were classified as PAMM. The cause-specific mortality did not differ between PAMM and MM not diagnosed near childbirth (adjusted hazard ratio 1.09, 95% confidence interval 0.83-1.42).


      Information on stage at diagnosis was available only for a subset of patients


      Overall, the cause-specific mortality in women and girls with PAMM did not differ from that in women and girls with non-PAMM. The current findings do not provide evidence of an adverse prognostic influence of pregnancy or a recent birth.

      Key words

      Abbreviations used:

      CI (confidence interval), FPM (flexible parametric survival model), HR (hazard ratio), MM (malignant melanoma), PAMM (pregnancy-associated malignant melanoma)
      To read this article in full you will need to make a payment
      AAD Member Login
      AAD Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Stensheim H.
        • Møller B.
        • van Dijk T.
        • Fossa S.D.
        Cause-specific survival for women diagnosed with cancer during pregnancy or lactation: a registry-based cohort study.
        J Clin Oncol. 2009; 27: 45-51
        • Pack G.T.
        • Scharnagel I.M.
        The prognosis for malignant melanoma in the pregnant woman.
        Cancer. 1951; 4: 324-334
        • Smith R.S.
        • Randall P.
        Melanoma during pregnancy.
        Obstet Gynecol. 1969; 34: 825-829
        • Baergen R.N.
        • Johnson D.
        • Moore T.
        • Benirschke K.
        Maternal melanoma metastatic to the placenta: a case report and review of the literature.
        Arch Pathol Lab Med. 1997; 121: 508-511
        • de Giorgi V.
        • Gori A.
        • Grazzini M.
        • Rossari S.
        • Scarfi F.
        • Corciova S.
        • et al.
        Estrogens, estrogen receptors and melanoma.
        Expert Rev Anticancer Ther. 2011; 11: 739-747
        • Shakhar K.
        • Valdimarsdottir H.B.
        • Bovbjerg D.H.
        Heightened risk of breast cancer following pregnancy: could lasting systemic immune alterations contribute?.
        Cancer Epidemiol Biomarkers Prev. 2007; 16: 1082-1086
        • Musey V.C.
        • Collins D.C.
        • Brogan D.R.
        • Santos V.R.
        • Musey P.I.
        • Martino-Saltzman D.
        • et al.
        Long term effects of a first pregnancy on the hormonal environment: estrogens and androgens.
        J Clin Endocrinol Metab. 1987; 64: 111-118
        • Tanemura A.
        • van Hoesel A.Q.
        • Mori T.
        • Yu T.
        • Hoon D.S.
        The role of estrogen receptor in melanoma.
        Expert Opin Ther Targets. 2007; 11: 1639-1648
        • Wong J.H.
        • Sterns E.E.
        • Kopald K.H.
        • Nizze J.A.
        • Morton D.L.
        Prognostic significance of pregnancy in stage I melanoma.
        Arch Surg. 1989; 124: 1227-1231
        • Daryanani D.
        • Plukker J.T.
        • De Hullu J.A.
        • Kuiper H.
        • Nap R.E.
        • Hoekstra H.J.
        Pregnancy and early-stage melanoma.
        Cancer. 2003; 97: 2248-2253
        • O'Meara A.T.
        • Cress R.
        • Xing G.
        • Danielsen B.
        • Smith L.H.
        Malignant melanoma in pregnancy: a population-based evaluation.
        Cancer. 2005; 103: 1217-1226
        • Lens M.B.
        • Rosdahl I.
        • Ahlbom A.
        • Farahmand B.Y.
        • Synnerstad I.
        • Boeryd B.
        • et al.
        Effect of pregnancy on survival in women with cutaneous malignant melanoma.
        J Clin Oncol. 2004; 22: 4369-4375
        • Lens M.
        • Rosdahl I.
        • Newton-Bishop J.
        Cutaneous melanoma during pregnancy: is the controversy over?.
        J Clin Oncol. 2009; 27 (author reply e3-4): e11-e12
        • MacKie R.M.
        • Bufalino R.
        • Morabito A.
        • Sutherland C.
        • Cascinelli N.
        Lack of effect of pregnancy on outcome of melanoma; for the World Health Organization melanoma program.
        Lancet. 1991; 337: 653-655
        • Travers R.L.
        • Sober A.J.
        • Berwick M.
        • Mihm Jr., M.C.
        • Barnhill R.L.
        • Duncan L.M.
        Increased thickness of pregnancy-associated melanoma.
        Br J Dermatol. 1995; 132: 876-883
        • McManamny D.S.
        • Moss A.L.
        • Pocock P.V.
        • Briggs J.C.
        Melanoma and pregnancy: a long-term follow-up.
        Br J Obstet Gynaecol. 1989; 96: 1419-1423
        • Slingluff Jr., C.L.
        • Reintgen D.S.
        • Vollmer R.T.
        • Seigler H.F.
        Malignant melanoma arising during pregnancy: a study of 100 patients.
        Ann Surg. 1990; 211: 552-559
        • Reintgen D.S.
        • McCarty Jr., K.S.
        • Vollmer R.
        • Cox E.
        • Seigler H.F.
        Malignant melanoma and pregnancy.
        Cancer. 1985; 55: 1340-1344
        • Vihinen P.
        • Vainio-Kaila M.
        • Talve L.
        • Koskivuo I.
        • Syrjanen K.
        • Pyrhonen S.
        Previous pregnancy is a favorable prognostic factor in women with localized cutaneous melanoma.
        Acta Oncol. 2012; 51: 662-668
        • Møller H.
        • Purushotham A.
        • Linklater K.M.
        • Garmo H.
        • Holmberg L.
        • Lambe M.
        • et al.
        Recent childbirth is an adverse prognostic factor in breast cancer and melanoma, but not in Hodgkin lymphoma.
        Eur J Cancer. 2013; 49: 3686-3693
        • Barlow L.
        • Westergren K.
        • Holmberg L.
        • Talback M.
        The completeness of the Swedish cancer register: a sample survey for year 1998.
        Acta Oncol. 2009; 48: 27-33
      1. Sobin LH, Wittekind C. TNM classification of malignant tumors. 6th ed. Hoboken, NJ: Wiley; 2002.

        • Royston P.
        • Parmar M.K.B.
        Flexible parametric proportional-hazards and proportional-odds models for censored survival data, with application to prognostic modeling and estimation of treatment effects.
        Stat Med. 2002; 21: 2175-2197
        • Lambert P.C.
        • Royston P.
        Further development of flexible parametric models for survival analysis.
        Stata J. 2009; 9: 265-290
        • Stensheim H.
        • Møller B.
        • van Dijk T.
        • Fosså S.D.
        Reply to Lens et al.
        J Clin Oncol. 2009; 27: e13-e14