Melanoma in Pregnancy: Dispelling Myths and Reviewing Diagnosis, Prognosis, and Treatment

Conclusions

• Melanoma during pregnancy generally behaves like melanoma in non-pregnant patients, with no consistent evidence of worse survival or recurrence from pregnancy itself.
• Most changes seen in ordinary melanocytic nevi during pregnancy are not evidence of malignancy, and any clinically, dermoscopically, or histologically atypical lesion should be biopsied rather than assumed to be physiologic.
• Women with dysplastic nevi or a personal/family history of melanoma warrant closer surveillance during pregnancy, typically with photography and trimester-based follow-up.
• The apparent association between pregnancy and worse melanoma outcomes in some reports is likely explained largely by delayed diagnosis and methodological flaws rather than a true biologic effect of pregnancy.
• Pregnancy-associated melanoma is not a reason to automatically defer future pregnancies after a thin or localized melanoma, though higher-risk cases may justify an individualized delay.
• When melanoma is diagnosed during pregnancy, standard management principles still apply, with surgery, imaging, and sentinel node evaluation possible using pregnancy-adapted precautions.
• Advanced melanoma in pregnancy requires special attention to placental examination because melanoma is the cancer most likely to metastasize to the placenta and, rarely, the fetus.
• Early-stage melanoma has little to no demonstrated adverse effect on fetal or gestational outcomes, whereas widespread maternal disease can drive neonatal risk.
• Oral contraceptives and hormone replacement therapy do not show a strong, consistent melanoma risk signal in most studies, so routine withholding is generally not supported by the evidence.