Melanoma in relation to reproductive and hormonal factors in women: current review on controversial issues

Purpose About one third of all melanoma in women occur during their childbearing age. An association between melanoma and hormonal and reproductive factors remains controversial. Methods This article reviews current evidence on the link between melanoma and reproductive factors. A comprehensive search of Medline (from 1966 to July 2007) and Embase (1974 to July 2007) was performed. Articles were reviewed and additional references were obtained from the bibliographies. Results Several controversial issues have been discussed. A pooled analysis of 10 case-control studies including a total of 5,590 women found a lack of association between melanoma risk and pregnancy. Data suggested that women with higher parity (five or more live births) had moderately lower melanoma risk compared with nulliparous women. Current evidence demonstrated that pregnancy did not appear to affect survival in women with melanoma. Based on the current evidence there is no reason to recommend deferral of subsequent pregnancy in women in whom a primary melanoma is diagnosed during pregnancy. The data revealed no relation between melanoma risk and use of oral contraceptives and hormone replacement therapy (HRT). Conclusion Exogenous or endogenous female hormones do not contribute significantly to increased risk of melanoma. Melanoma prognosis does not appear to be affected by pregnancy. Termination of pregnancy in women diagnosed with a primary melanoma during pregnancy is not recommended. There is no evidence to support deferral of pregnancy in women with melanoma history except that at the end of 2 years patients have a better estimate of their risk of recurrence.