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Fertility treatments and melanoma

Forums General Melanoma Community Fertility treatments and melanoma

  • Post
    MaryMary73
    Participant

    I began fertility treatments in January 2010. The procedure is invitro fertilization. So after undergoing the standard hormone treatments, 22 eggs matured. Almost unheard of and so much so that I had ovarian hyperstimulation. Very painful. Out of the 22 eggs, 13 were successfully fertilized and became embryos. I had my first 3 embryos transferred in May 2010 but none took. I had the next 3 transferred in August 2010 which resulted in an heterotopic pregnancy of 1 embryo (emergency surgery to remove burst fallopian tube) and a miscarriage of the other 2.

    I began fertility treatments in January 2010. The procedure is invitro fertilization. So after undergoing the standard hormone treatments, 22 eggs matured. Almost unheard of and so much so that I had ovarian hyperstimulation. Very painful. Out of the 22 eggs, 13 were successfully fertilized and became embryos. I had my first 3 embryos transferred in May 2010 but none took. I had the next 3 transferred in August 2010 which resulted in an heterotopic pregnancy of 1 embryo (emergency surgery to remove burst fallopian tube) and a miscarriage of the other 2. My husband and I decided to wait a bit…emotionally, I was a wreck and I was physically tired.

    Melanoma rears its ugly head in November 2010. While sitting at home depressed about my crappy luck during the whole month of November, I happened to Google "fertility treatments and melanoma". It seems that research has been done that may link the two. I bring this up with my fertility doctor and he tells me that he has never heard of fertility treatments causing melanoma but he does confirm that the hormones given to stimulate the ovaries are extremely powerful. Hmmmmm.

    I have 7 embryos left. I am 37 years old. Stuck between wanting a child but not wanting to risk a melanoma recurrence.

    Can pregnancy raise the risk of a melanoma recurrence? Does anyone know?

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  • Replies
      KatyWI
      Participant

      I did a little research on this topic when my husband and I were trying, and again when we learned we had little chance of getting pregnant without outside help.  However, every time I so much as think about a baby, I recur.  So even if I get back to NED now, it's permanently off the table.  I'm getting too old.  But, here are my notes.  They're quite long; sorry but I hope you learn something valuable to you.  Bottom line is that some researchers feel there is a link, and some don't.  Ultimately it is a personal decision, because nobody has the answers with this disease.  Good luck…I feel for you.  We have two boys from hubby's first marriage but I've never had a child, and we both really wanted another.

      KatyWI

       

      Am J Epidemiol. 2009 Feb 1;169(3):365-75. Epub 2008 Nov 26.

      Cancer risk after exposure to treatments for ovulation induction.

      Calderon-Margalit R, Friedlander Y, Yanetz R, Kleinhaus K, Perrin MC, Manor O, Harlap S, Paltiel O.

      Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem, Israel. [email protected]

      Abstract

      Uncertainty continues as to whether treatments for ovulation induction are associated with increased risk of cancer. The authors conducted a long-term population-based historical cohort study of parous women. A total of 15,030 women in the Jerusalem Perinatal Study who gave birth in 1974-1976 participated in a postpartum survey. Cancer incidence through 2004 was analyzed using Cox's proportional hazards models, controlling for age and other covariates. Women who used drugs to induce ovulation (n = 567) had increased risks of cancer at any site (multivariate hazard ratio (HR) = 1.36, 95% confidence interval (CI): 1.06, 1.74). An increased risk of uterine cancer was found among women treated with ovulation-inducing agents (HR = 3.39, 95% CI: 1.28, 8.97), specifically clomiphene (HR = 4.56, 95% CI: 1.56, 13.34). No association was noted between use of ovulation-inducing agents and ovarian cancer (age-adjusted HR = 0.61, 95% CI: 0.08, 4.42). Ovulation induction was associated with a borderline-significant increased risk of breast cancer (multivariate HR = 1.42, 95% CI: 0.99, 2.05). Increased risks were also observed for malignant melanoma and non-Hodgkin lymphoma. These associations appeared stronger among women who waited more than 1 year to conceive. Additional follow-up studies assessing these associations by drug type, dosage, and duration are needed.

       

       

      Cancer Causes Control. 2008 Sep;19(7):759-65. Epub 2008 Mar 14.

      Malignant melanoma risk after exposure to fertility drugs: results from a large Danish cohort study.

      Hannibal CG, Jensen A, Sharif H, Kjaer SK.

      Department of Viruses, Hormones and Cancer, Institute of Cancer Epidemiology, Danish Cancer Society, Strandboulevarden 49, 2100, Copenhagen, Denmark.

      Abstract

      OBJECTIVE: The aim was to examine the effects of fertility drugs on malignant melanoma risk using data from the largest cohort of infertile women to date.

      METHODS: A cohort of 54,362 women with infertility problems referred to Danish fertility clinics in the period 1963-1998 was established. A detailed data collection including information about type and amount of treatment was conducted. Using case-cohort techniques, we calculated rate ratios (RRs) of malignant melanoma associated with different fertility drugs after adjustment for parity status.

      RESULTS: 112 malignant melanomas were identified during follow-up through 2000. Use of clomiphene, gonadotrophins, hCG or GnRH did not affect risk of malignant melanoma significantly. When stratifying for parity, however, use of gonadotrophins (RR = 2.29; CI: 1.16-4.52) or GnRH (RR = 3.26; 95% CI: 1.50-7.09) among parous women was associated with a significant increased risk. For all groups of fertility drugs, we found no association with number of cycles of use or years since first use (latency).

      CONCLUSIONS: Our findings showed no strong association between malignant melanoma risk and use of fertility drugs, although the results indicated that use of gonadotrophins or GnRH might increase risk in parous women. Longer follow-up is needed to confirm our findings.

       

       

      Am J Obstet Gynecol. 1999 Jun;180(6 Pt 1):1499-503.

      Malignant melanoma of the ovary and exposure to clomiphene citrate: a case report and review of the literature.

      Fuller PN.

      Kaiser Permanente Medical Center, Riverside, CA, 92505, USA.

      Abstract

      OBJECTIVE: The purpose of this article is to present a case of metastatic malignant melanoma of the ovary, a review of the current literature, and current recommendations for preventative and consultative management.

      STUDY DESIGN: This is a case report and literature review. A 34-year-old woman had symptoms of pelvic abscess 1 month after clomiphene citrate stimulation for infertility. After a failed course of antibiotic therapy, an exploratory laparotomy was performed. Bilateral malignant melanomas of the ovary were discovered. The patient died 4 weeks later of disseminated metastases. Retrospectively, a history of a "mole" with unknown histopathologic characteristics had been removed from her arm 15 years earlier. A review of the literature was performed to provide current findings regarding malignant melanomas of the ovary, as well as to evaluate the potential relationship between the use of ovarian stimulating drugs and the development of melanomas.

      RESULTS: Melanomas account for 3% of cancers, but the incidence of melanoma is rising. Genital melanomas are uncommon; the primary site is the vulva. Primary malignant melanoma of the ovary is rare; however, delayed recurrence from a primary skin site with metastasis to the ovary is documented. The literature suggests a possible relationship between the use of clomiphene citrate and an increase in melanomas of the skin.

      CONCLUSION: The gynecologist, as a primary provider, must be aware of the increasing incidence of malignant melanoma, as well as the recommendations for prevention. The gynecologist, as a consultant, must be aware of the risk of delayed recurrence of malignant melanoma. The potential for development of melanomas associated with the use of ovarian stimulation for infertility needs further monitoring and analysis.

       

       

      Melanoma Res. 1992 May;2(1):71-4.

      Multiple primary melanomas in a patient with familial-type DNS during clomiphene-induced pregnancy.

      Kuppens E, Bergman W, Welvaart K, Bruijn JA, Scheffer E.

      Department of Dermatology, University Medical Center, Leiden, The Netherlands.

      Abstract

      A 35-year old woman developed six primary cutaneous melanomas during her third pregnancy. She had received clomiphene treatment for nearly 2 years previously. She developed two more primary melanomas 15 and 21 months after giving birth. All melanomas were histologically associated with preexisting dysplastic naevi. The patient showed the characteristic phenotype of the dysplastic naevus syndrome; a cousin and an aunt were treated for malignant melanoma and the patient's brother had histologically confirmed dysplastic naevi. The course of her first two pregnancies was not complicated by the development of melanomas. We suggest that clomiphene may have played a role in the activation or progression of these 'precursor lesions' into malignant melanoma.

       

      http://www.nature.com/bjc/journal/v100/n11/full/6605086a.html

      British Journal of Cancer (2009) 100, 1824–1831. doi:10.1038/sj.bjc.6605086 http://www.bjcancer.com

      Published online 12 May 2009

      Ovulation-stimulation drugs and cancer risks: a long-term follow-up of a British cohort

      I dos Santos Silva1, P A Wark1,4, V A McCormack1,4, D Mayer1, C Overton2,4, V Little2, J Nieto3,4, P Hardiman3, M Davies2 and A B MacLean3

      To assess long-term health effects of ovarian-stimulation drugs we followed-up for over 20 years a British cohort of 7355 women with ovulatory disorders, 43% of whom were prescribed ovarian-stimulation drugs, and identified a total of 274 deaths and 367 incident cancers. Relative to the general population, the cohort experienced lower mortality from most causes, including from all neoplasms combined, and lower incidence of cervical cancer, but higher incidence of cancers of the breast (relative risk: 1.13; 95% CI 0.97, 1.30) and corpus uteri (2.02; 1.37, 2.87). There were, however, no significant differences in the risk of cancers of the breast, corpus uteri, ovary, or of any other site, between women who had been prescribed ovarian-stimulation drugs and those who had not. Further analyses by type of drug and dose revealed a dose–response gradient in the risk of cancer of the corpus uteri (P for linear trend=0.03), with women given 2250 mg of clomiphene having a 2.6-fold (2.62; 0.94, 6.82) increase in risk relative to those who were not treated. These findings do not support strong associations between ovulation-stimulation drugs and cancer risks, but they indicate the need for continued monitoring to establish whether risks are elevated in certain subgroups of users.

      *No association with MM was observed.

       

      G Ital Dermatol Venereol. 2008 Aug;143(4):251-7.

      Melanoma and pregnancy.

      Driscoll MS, Grant-Kels JM.

      Department of Dermatology, University of Maryland School of Medicine, Baltimore, MD 21201, USA. [email protected]

      Abstract

      Herein we analyze three important issues concerning melanoma and pregnancy: 1) While initial case reports and case series predicted a grim prognosis for the woman diagnosed with melanoma during pregnancy, we summarize more recent controlled studies that suggest that pregnancy has no effect on survival in women diagnosed with localized cutaneous melanoma. 2) We review the prognosis for the fetus when a woman is diagnosed with melanoma during pregnancy. While melanoma is the most common malignancy to metastasize to the placenta, metastatic melanoma to the fetus appears to be a rare event. 3) How do we answer questions about future pregnancies and hormonal therapy when counseling women who have been diagnosed with melanoma during pregnancy or the childbearing years? Will future pregnancies worsen prognosis? Based on limited data, pregnancies subsequent to a diagnosis of localized melanoma do not appear to impact prognosis. Are oral contraceptive pills or hormonal replacement therapy contraindicated in these women? Strong epidemiologic evidence suggests that exposure to oral contraceptive pills do not increase the risk for melanoma. Although only a small number of studies have addressed the risk of hormone replacement therapy, the reports demonstrate that this also does not appear to enhance the risk for developing melanoma.

       

      J Plast Reconstr Aesthet Surg. 2010 Jul;63(7):1163-8. Epub 2009 Jul 9.

      Malignant melanoma and pregnancy: second thoughts.

      Miller E, Barnea Y, Gur E, Leshem D, Karin E, Weiss J, Schneebaum S.

      Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

      Abstract

      Malignant melanoma (MM) was considered a hormone-sensitive tumour, and pregnancy was thought to increase its risk and cause faster progression and earlier metastasis. Several controlled studies demonstrated similar survival rates between pregnant and non-pregnant patients and concluded that early reports of advanced MM of pregnancy were probably due to late diagnosis. We retrieved information from our database between 1997 and 2006 on all patients diagnosed as having MM during and up to 6 months after pregnancy (n=11) and compared them to age-matched, non-pregnant, MM patients (n=65, controls) treated by us during that period. The mean Breslow thickness was 4.28mm for the pregnant patients and 1.69mm for the controls (p=0.15). The sentinel nodes were metastatic in five pregnant patients compared to four controls (p<0.0001). Two patients in the pregnancy group and one control died of MM (p=0.0532). Our results indicate a negative effect of pregnancy on the course of MM.

       

      Semin Oncol. 2000 Dec;27(6):654-6.

      Melanoma and pregnancy.

      Borden EC.

      Taussig Cancer Center, Cleveland Clinic Foundation, OH 44195, USA.

      Abstract

      The only consistent factor influencing prognosis of primary melanoma in pregnancy has been the stage of disease at diagnosis, not the pregnancy. However, several studies suggest that pregnant women may have melanoma diagnosed at a later stage of disease. Thus, suspicious changes in nevi during pregnancy warrant prompt biopsy-not observation or deferral to the postpartum period. No hormonal factors in pregnancy that clearly influence melanoma development have been identified; there is no increased risk of recurrent disease with subsequent pregnancy. Thus, the decision for further childbearing should be a prognostic and personal one. Placental and/or fetal metastasis are limited to patients with hematogenous dissemination. Except possibly for this reason in women with distant metastases, there are no medical data to justify therapeutic abortion. Recommendations to the pregnant woman or the woman of reproductive age should not differ from that of other patients with melanoma.

       

       

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1303387/pdf/westjmed00353-0060.pdf

      West J Med. 1996 February; 164(2): 156–161. 

      Malignant melanoma and pregnancy ten questions.

      R O Dillman, L A Vandermolen, N M Barth, and K J Bransford

       8. Should women who previously were diagnosed with melanoma avoid pregnancy?

      The issue here is whether pregnancy activates micrometastatic disease. There is no convincing evidence that pregnancy activates or stimulates dormant micrometastatic disease, although anecdotal case reports certainly suggest that this may happen in some cases. One of the difficulties in addressing this question is that it is impossible to know prospectively which patients are harboring micrometastases. One author noted similar five and ten-year survival rates for 115 patients who were pregnant with melanoma compared with 330 female melanoma patients who were never pregnant during or after their diagnosis.' The pregnant group, however, had a higher frequency of lymph node involvement at the time of diagnosis. A better survival was actually noted for 71 patients who were pregnant within a year before or five years after a diagnosis of melanoma, but the control group consisted of only 31 women who did not get pregnant during a similar interval and who actually had higher stage disease.47 In another study, women diagnosed with melanoma before getting pregnant were compared with women diagnosed after completing all pregnancies.39 The latter group actually appeared to do worse at five years, although statistical comparison was not provided. In a retrospective study conducted at Duke University, 43 women with stage I melanoma who became pregnant within the next five years had prognoses similar to those of 337 women who did not get pregnant, both in terms of relapse and disease-free survival.

      Loading spinner
        khen
        Participant
        In Vitro Fertilization Center</a>  is an acronym for in vitro fertilization ('in vitro' meaning 'in glass'). Simply put IVF is adding a man's sperm to his female partner’s eggs in the laboratory to produce embryos. In vitro fertilization is an option for many couples who cannot conceive through conventional therapies. These embryos are put back into the female partner's uterus (womb) after 3 to 5 days of being in the incubator, hopefully they will then grow into a baby. The reasons IVF is done include – poor sperm quality and/or quantity, obstructions between the egg and sperm, ovulation problems, and sperm-egg interaction problems. These problems can prevent couples having a baby naturally, and IVF helps to solve this.
        Loading spinner
        khen
        Participant
        In Vitro Fertilization Center</a>  is an acronym for in vitro fertilization ('in vitro' meaning 'in glass'). Simply put IVF is adding a man's sperm to his female partner’s eggs in the laboratory to produce embryos. In vitro fertilization is an option for many couples who cannot conceive through conventional therapies. These embryos are put back into the female partner's uterus (womb) after 3 to 5 days of being in the incubator, hopefully they will then grow into a baby. The reasons IVF is done include – poor sperm quality and/or quantity, obstructions between the egg and sperm, ovulation problems, and sperm-egg interaction problems. These problems can prevent couples having a baby naturally, and IVF helps to solve this.
        Loading spinner
        khen
        Participant
        In Vitro Fertilization Center</a>  is an acronym for in vitro fertilization ('in vitro' meaning 'in glass'). Simply put IVF is adding a man's sperm to his female partner’s eggs in the laboratory to produce embryos. In vitro fertilization is an option for many couples who cannot conceive through conventional therapies. These embryos are put back into the female partner's uterus (womb) after 3 to 5 days of being in the incubator, hopefully they will then grow into a baby. The reasons IVF is done include – poor sperm quality and/or quantity, obstructions between the egg and sperm, ovulation problems, and sperm-egg interaction problems. These problems can prevent couples having a baby naturally, and IVF helps to solve this.
        Loading spinner
      KatyWI
      Participant

      I did a little research on this topic when my husband and I were trying, and again when we learned we had little chance of getting pregnant without outside help.  However, every time I so much as think about a baby, I recur.  So even if I get back to NED now, it's permanently off the table.  I'm getting too old.  But, here are my notes.  They're quite long; sorry but I hope you learn something valuable to you.  Bottom line is that some researchers feel there is a link, and some don't.  Ultimately it is a personal decision, because nobody has the answers with this disease.  Good luck…I feel for you.  We have two boys from hubby's first marriage but I've never had a child, and we both really wanted another.

      KatyWI

       

      Am J Epidemiol. 2009 Feb 1;169(3):365-75. Epub 2008 Nov 26.

      Cancer risk after exposure to treatments for ovulation induction.

      Calderon-Margalit R, Friedlander Y, Yanetz R, Kleinhaus K, Perrin MC, Manor O, Harlap S, Paltiel O.

      Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem, Israel. [email protected]

      Abstract

      Uncertainty continues as to whether treatments for ovulation induction are associated with increased risk of cancer. The authors conducted a long-term population-based historical cohort study of parous women. A total of 15,030 women in the Jerusalem Perinatal Study who gave birth in 1974-1976 participated in a postpartum survey. Cancer incidence through 2004 was analyzed using Cox's proportional hazards models, controlling for age and other covariates. Women who used drugs to induce ovulation (n = 567) had increased risks of cancer at any site (multivariate hazard ratio (HR) = 1.36, 95% confidence interval (CI): 1.06, 1.74). An increased risk of uterine cancer was found among women treated with ovulation-inducing agents (HR = 3.39, 95% CI: 1.28, 8.97), specifically clomiphene (HR = 4.56, 95% CI: 1.56, 13.34). No association was noted between use of ovulation-inducing agents and ovarian cancer (age-adjusted HR = 0.61, 95% CI: 0.08, 4.42). Ovulation induction was associated with a borderline-significant increased risk of breast cancer (multivariate HR = 1.42, 95% CI: 0.99, 2.05). Increased risks were also observed for malignant melanoma and non-Hodgkin lymphoma. These associations appeared stronger among women who waited more than 1 year to conceive. Additional follow-up studies assessing these associations by drug type, dosage, and duration are needed.

       

       

      Cancer Causes Control. 2008 Sep;19(7):759-65. Epub 2008 Mar 14.

      Malignant melanoma risk after exposure to fertility drugs: results from a large Danish cohort study.

      Hannibal CG, Jensen A, Sharif H, Kjaer SK.

      Department of Viruses, Hormones and Cancer, Institute of Cancer Epidemiology, Danish Cancer Society, Strandboulevarden 49, 2100, Copenhagen, Denmark.

      Abstract

      OBJECTIVE: The aim was to examine the effects of fertility drugs on malignant melanoma risk using data from the largest cohort of infertile women to date.

      METHODS: A cohort of 54,362 women with infertility problems referred to Danish fertility clinics in the period 1963-1998 was established. A detailed data collection including information about type and amount of treatment was conducted. Using case-cohort techniques, we calculated rate ratios (RRs) of malignant melanoma associated with different fertility drugs after adjustment for parity status.

      RESULTS: 112 malignant melanomas were identified during follow-up through 2000. Use of clomiphene, gonadotrophins, hCG or GnRH did not affect risk of malignant melanoma significantly. When stratifying for parity, however, use of gonadotrophins (RR = 2.29; CI: 1.16-4.52) or GnRH (RR = 3.26; 95% CI: 1.50-7.09) among parous women was associated with a significant increased risk. For all groups of fertility drugs, we found no association with number of cycles of use or years since first use (latency).

      CONCLUSIONS: Our findings showed no strong association between malignant melanoma risk and use of fertility drugs, although the results indicated that use of gonadotrophins or GnRH might increase risk in parous women. Longer follow-up is needed to confirm our findings.

       

       

      Am J Obstet Gynecol. 1999 Jun;180(6 Pt 1):1499-503.

      Malignant melanoma of the ovary and exposure to clomiphene citrate: a case report and review of the literature.

      Fuller PN.

      Kaiser Permanente Medical Center, Riverside, CA, 92505, USA.

      Abstract

      OBJECTIVE: The purpose of this article is to present a case of metastatic malignant melanoma of the ovary, a review of the current literature, and current recommendations for preventative and consultative management.

      STUDY DESIGN: This is a case report and literature review. A 34-year-old woman had symptoms of pelvic abscess 1 month after clomiphene citrate stimulation for infertility. After a failed course of antibiotic therapy, an exploratory laparotomy was performed. Bilateral malignant melanomas of the ovary were discovered. The patient died 4 weeks later of disseminated metastases. Retrospectively, a history of a "mole" with unknown histopathologic characteristics had been removed from her arm 15 years earlier. A review of the literature was performed to provide current findings regarding malignant melanomas of the ovary, as well as to evaluate the potential relationship between the use of ovarian stimulating drugs and the development of melanomas.

      RESULTS: Melanomas account for 3% of cancers, but the incidence of melanoma is rising. Genital melanomas are uncommon; the primary site is the vulva. Primary malignant melanoma of the ovary is rare; however, delayed recurrence from a primary skin site with metastasis to the ovary is documented. The literature suggests a possible relationship between the use of clomiphene citrate and an increase in melanomas of the skin.

      CONCLUSION: The gynecologist, as a primary provider, must be aware of the increasing incidence of malignant melanoma, as well as the recommendations for prevention. The gynecologist, as a consultant, must be aware of the risk of delayed recurrence of malignant melanoma. The potential for development of melanomas associated with the use of ovarian stimulation for infertility needs further monitoring and analysis.

       

       

      Melanoma Res. 1992 May;2(1):71-4.

      Multiple primary melanomas in a patient with familial-type DNS during clomiphene-induced pregnancy.

      Kuppens E, Bergman W, Welvaart K, Bruijn JA, Scheffer E.

      Department of Dermatology, University Medical Center, Leiden, The Netherlands.

      Abstract

      A 35-year old woman developed six primary cutaneous melanomas during her third pregnancy. She had received clomiphene treatment for nearly 2 years previously. She developed two more primary melanomas 15 and 21 months after giving birth. All melanomas were histologically associated with preexisting dysplastic naevi. The patient showed the characteristic phenotype of the dysplastic naevus syndrome; a cousin and an aunt were treated for malignant melanoma and the patient's brother had histologically confirmed dysplastic naevi. The course of her first two pregnancies was not complicated by the development of melanomas. We suggest that clomiphene may have played a role in the activation or progression of these 'precursor lesions' into malignant melanoma.

       

      http://www.nature.com/bjc/journal/v100/n11/full/6605086a.html

      British Journal of Cancer (2009) 100, 1824–1831. doi:10.1038/sj.bjc.6605086 http://www.bjcancer.com

      Published online 12 May 2009

      Ovulation-stimulation drugs and cancer risks: a long-term follow-up of a British cohort

      I dos Santos Silva1, P A Wark1,4, V A McCormack1,4, D Mayer1, C Overton2,4, V Little2, J Nieto3,4, P Hardiman3, M Davies2 and A B MacLean3

      To assess long-term health effects of ovarian-stimulation drugs we followed-up for over 20 years a British cohort of 7355 women with ovulatory disorders, 43% of whom were prescribed ovarian-stimulation drugs, and identified a total of 274 deaths and 367 incident cancers. Relative to the general population, the cohort experienced lower mortality from most causes, including from all neoplasms combined, and lower incidence of cervical cancer, but higher incidence of cancers of the breast (relative risk: 1.13; 95% CI 0.97, 1.30) and corpus uteri (2.02; 1.37, 2.87). There were, however, no significant differences in the risk of cancers of the breast, corpus uteri, ovary, or of any other site, between women who had been prescribed ovarian-stimulation drugs and those who had not. Further analyses by type of drug and dose revealed a dose–response gradient in the risk of cancer of the corpus uteri (P for linear trend=0.03), with women given 2250 mg of clomiphene having a 2.6-fold (2.62; 0.94, 6.82) increase in risk relative to those who were not treated. These findings do not support strong associations between ovulation-stimulation drugs and cancer risks, but they indicate the need for continued monitoring to establish whether risks are elevated in certain subgroups of users.

      *No association with MM was observed.

       

      G Ital Dermatol Venereol. 2008 Aug;143(4):251-7.

      Melanoma and pregnancy.

      Driscoll MS, Grant-Kels JM.

      Department of Dermatology, University of Maryland School of Medicine, Baltimore, MD 21201, USA. [email protected]

      Abstract

      Herein we analyze three important issues concerning melanoma and pregnancy: 1) While initial case reports and case series predicted a grim prognosis for the woman diagnosed with melanoma during pregnancy, we summarize more recent controlled studies that suggest that pregnancy has no effect on survival in women diagnosed with localized cutaneous melanoma. 2) We review the prognosis for the fetus when a woman is diagnosed with melanoma during pregnancy. While melanoma is the most common malignancy to metastasize to the placenta, metastatic melanoma to the fetus appears to be a rare event. 3) How do we answer questions about future pregnancies and hormonal therapy when counseling women who have been diagnosed with melanoma during pregnancy or the childbearing years? Will future pregnancies worsen prognosis? Based on limited data, pregnancies subsequent to a diagnosis of localized melanoma do not appear to impact prognosis. Are oral contraceptive pills or hormonal replacement therapy contraindicated in these women? Strong epidemiologic evidence suggests that exposure to oral contraceptive pills do not increase the risk for melanoma. Although only a small number of studies have addressed the risk of hormone replacement therapy, the reports demonstrate that this also does not appear to enhance the risk for developing melanoma.

       

      J Plast Reconstr Aesthet Surg. 2010 Jul;63(7):1163-8. Epub 2009 Jul 9.

      Malignant melanoma and pregnancy: second thoughts.

      Miller E, Barnea Y, Gur E, Leshem D, Karin E, Weiss J, Schneebaum S.

      Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

      Abstract

      Malignant melanoma (MM) was considered a hormone-sensitive tumour, and pregnancy was thought to increase its risk and cause faster progression and earlier metastasis. Several controlled studies demonstrated similar survival rates between pregnant and non-pregnant patients and concluded that early reports of advanced MM of pregnancy were probably due to late diagnosis. We retrieved information from our database between 1997 and 2006 on all patients diagnosed as having MM during and up to 6 months after pregnancy (n=11) and compared them to age-matched, non-pregnant, MM patients (n=65, controls) treated by us during that period. The mean Breslow thickness was 4.28mm for the pregnant patients and 1.69mm for the controls (p=0.15). The sentinel nodes were metastatic in five pregnant patients compared to four controls (p<0.0001). Two patients in the pregnancy group and one control died of MM (p=0.0532). Our results indicate a negative effect of pregnancy on the course of MM.

       

      Semin Oncol. 2000 Dec;27(6):654-6.

      Melanoma and pregnancy.

      Borden EC.

      Taussig Cancer Center, Cleveland Clinic Foundation, OH 44195, USA.

      Abstract

      The only consistent factor influencing prognosis of primary melanoma in pregnancy has been the stage of disease at diagnosis, not the pregnancy. However, several studies suggest that pregnant women may have melanoma diagnosed at a later stage of disease. Thus, suspicious changes in nevi during pregnancy warrant prompt biopsy-not observation or deferral to the postpartum period. No hormonal factors in pregnancy that clearly influence melanoma development have been identified; there is no increased risk of recurrent disease with subsequent pregnancy. Thus, the decision for further childbearing should be a prognostic and personal one. Placental and/or fetal metastasis are limited to patients with hematogenous dissemination. Except possibly for this reason in women with distant metastases, there are no medical data to justify therapeutic abortion. Recommendations to the pregnant woman or the woman of reproductive age should not differ from that of other patients with melanoma.

       

       

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1303387/pdf/westjmed00353-0060.pdf

      West J Med. 1996 February; 164(2): 156–161. 

      Malignant melanoma and pregnancy ten questions.

      R O Dillman, L A Vandermolen, N M Barth, and K J Bransford

       8. Should women who previously were diagnosed with melanoma avoid pregnancy?

      The issue here is whether pregnancy activates micrometastatic disease. There is no convincing evidence that pregnancy activates or stimulates dormant micrometastatic disease, although anecdotal case reports certainly suggest that this may happen in some cases. One of the difficulties in addressing this question is that it is impossible to know prospectively which patients are harboring micrometastases. One author noted similar five and ten-year survival rates for 115 patients who were pregnant with melanoma compared with 330 female melanoma patients who were never pregnant during or after their diagnosis.' The pregnant group, however, had a higher frequency of lymph node involvement at the time of diagnosis. A better survival was actually noted for 71 patients who were pregnant within a year before or five years after a diagnosis of melanoma, but the control group consisted of only 31 women who did not get pregnant during a similar interval and who actually had higher stage disease.47 In another study, women diagnosed with melanoma before getting pregnant were compared with women diagnosed after completing all pregnancies.39 The latter group actually appeared to do worse at five years, although statistical comparison was not provided. In a retrospective study conducted at Duke University, 43 women with stage I melanoma who became pregnant within the next five years had prognoses similar to those of 337 women who did not get pregnant, both in terms of relapse and disease-free survival.

      Loading spinner
      JerryfromFauq
      Participant

      Suggest you ask this question of Dr. Wen Jen Hwo @ MDA.   ( [email protected] ).  I was at a briefing several years ago that she related the presence of estrogen receptors on individual females tumors to the possible relationsip between pregnancy and melanoma re-occurance.  Good luck, many here would like to hear what you learn.

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      JerryfromFauq
      Participant

      Suggest you ask this question of Dr. Wen Jen Hwo @ MDA.   ( [email protected] ).  I was at a briefing several years ago that she related the presence of estrogen receptors on individual females tumors to the possible relationsip between pregnancy and melanoma re-occurance.  Good luck, many here would like to hear what you learn.

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      JerryfromFauq
      Participant

      Suggest you ask this question of Dr. Wen Jen Hwo @ MDA.   ( [email protected] ).  I was at a briefing several years ago that she related the presence of estrogen receptors on individual females tumors to the possible relationsip between pregnancy and melanoma re-occurance.  Good luck, many here would like to hear what you learn.

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The MRF Patient Forum is the oldest and largest online community of people affected by melanoma. It is designed to provide peer support and information to caregivers, patients, family and friends. There is no better place to discuss different parts of your journey with this cancer and find the friends and support resources to make that journey more bearable.

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