Hormones, nevi, and melanoma: An approach to the patient - 19/08/11

Doi : 10.1016/j.jaad.2007.08.045

Marcia S. Driscoll, MD, PharmD ^a,^⁎ , Jane M. Grant-Kels, MD ^b
^a Department of Dermatology, University of Maryland School of Medicine, Baltimore, Maryland
^b Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut

Reprint requests: Marcia Sanford Driscoll, University of Maryland School of Medicine, Dermatology, 405 W Redwood St, 6th Floor, Baltimore, MD 21201.

Abstract

For many years, clinicians have been concerned about a potential adverse effect of pregnancy-associated hormones and exogenous hormones on melanocytic nevi and malignant melanoma. Today, these issues are more significant as women have delayed childbearing into their 30’s and 40’s, and the likelihood of diagnosis with melanoma during pregnancy is enhanced. More recent clinical, epidemiologic, and laboratory studies have shed some light on the relationship among hormones, nevi, and melanoma in pregnancy.

Learning objectives

In this review, we hope to provide the clinician with the most recent information to help them address (1) changes in nevi during pregnancy; (2) the influence on the prognosis for women diagnosed with melanoma before, during, or after pregnancy; (3) the characteristics of melanomas diagnosed during pregnancy; (4) the evaluation and treatment of the woman diagnosed with melanoma during pregnancy; and (5) counseling of women diagnosed with melanoma during the childbearing years concerning future pregnancy, oral contraceptive pills, and hormone replacement therapy. In addition, we will evaluate clinical and/or laboratory evidence regarding a relationship between hormones and melanocytic nevi or melanoma.

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Abbreviations used : AJCC, CT, DFI, DNS, ER, FDA, HRT, MM, MRI, OCP, SLN, TDS

Plan

Introduction

Do nevi typically change during pregnancy, and, if so, in what manner? Do dysplastic nevi typically change during pregnancy, and, if so, in what manner?

If MM is diagnosed during pregnancy, does this alter the prognosis of the mother or fetus?

If MM is diagnosed before pregnancy, does this alter the woman’s prognosis?

If MM is diagnosed after pregnancy, does this alter the woman’s prognosis?

Do melanomas diagnosed during pregnancy differ clinically or histologically from those diagnosed in the nonpregnant patient?

If melanoma is diagnosed during pregnancy, how does the evaluation and treatment of the patient differ from that indicated in the non-pregnant patient?

If melanoma is diagnosed during pregnancy or during the childbearing years, what advice should be given concerning future pregnancies and/or the use of oral contraceptives or hormonal replacement therapy?

Is there clinical or laboratory evidence for a link between hormones (or other growth factors) and either nevi or melanoma?

Conclusion

	Funding sources: None.
	Conflicts of interest: None declared.

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Vol 57 - N° 6

P. 919-931 - décembre 2007 Retour au numéro

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Hormones, nevi, and melanoma: An approach to the patient - 19/08/11

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