Primary Cutaneous Melanoma and Pregnancy

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2019 AAD Guidelines for management of Primary Cutaneous Melanoma (CM)
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anum Ijaz M.B.B.S., M.D.[2]

Overview

Cutaneous melanoma (CM) has been reported as the most common malignancy during pregnancy , but current evidence shows pregnancy does not increase CM risk or worsen prognosis. In fact, higher parity and younger age at first birth may offer a protective effect, while tanning behaviors remain a clear risk factor.

2019 AAD Guidelines for Management of Primary Cutaneous Melanoma in Pregnancy

Recommendations for management of CM and Pregnancy

Class B

1. In women with a history of CM, a prolonged waiting period before subsequent pregnancy is not recommended. Factors that affect disease recurrence, including CM thickness and stage, as well as age and fertility of the mother, should determine whether a woman with a history of CM should delay becoming pregnant and for how long.(Level Ⅱ)

2. Exogenous hormones (eg, oral contraceptives and hormone-containing contraceptive devices/implants, postmenopausal hormone replacement therapy, or hormones associated with assisted reproductive technology) may be used in women in whom CM has been diagnosed.(Level Ⅰ/Ⅱ )

Class C

1. In a pregnant woman with CM, a tailored, multidisciplinary approach to care that involves the obstetrician and CM specialists relevant to the patient’s stage of disease is recommended. A diagnosis of CM during pregnancy does not alter prognosis or outcome for the woman; however, work-up and treatment must take the safety of the fetus into consideration. (Level Ⅲ,Expert Opinion)

2. The approach to melanocytic nevi in the pregnant woman should be identical to that in the nonpregnant patient. Any changing nevus during pregnancy should be evaluated and subjected to biopsy if clinically and/or dermoscopically concerning.(Level Ⅲ)