Nevi and melanoma in the pregnant woman

Multiple difficult questions arise when a pregnant woman presents to the dermatologist with a changing melanocytic nevus or melanoma. Our review of the literature provides some insight into these issues. We recommend that a changing pigmented lesion in the pregnant woman should be biopsied promptly and can be safely performed. Women who have dysplastic nevus syndrome require closer monitoring during pregnancy. For the pregnant woman with a confirmed, localized melanoma, prognosis does not appear to be affected by pregnancy. Likewise, limited data indicate that pregnancy before or after a diagnosis of melanoma does not affect prognosis. Wide local excision may be performed safely, but if sentinel lymph node mapping and biopsy is indicated, the technique and safety of this procedure in the pregnant woman remains controversial. There appears to be no absolute contraindication to the prescription of oral contraceptive pills or hormone replacement therapy in someone who has been previously diagnosed with melanoma if no reasonable alternative exists. (C) 2009 Elsevier Inc. All rights reserved.