title: Previous pregnancy is a favourable prognostic factor in women with localised cutaneous melanoma.
abstract: BACKGROUND
  The influence of pregnancy on survival in melanoma has been a controversial issue.
  
  
  OBJECTIVE
  In this retrospective study we investigated whether pregnancy (overall or temporally melanoma-related) has any effect on melanoma progression or patient outcome.
  
  
  METHODS
  Patient data were collected from Turku University Hospital records concerning all women in fertile age (15-45 years) and diagnosed with melanoma between January 1, 1990 and December 31, 2009. We collected data on melanoma characteristics, treatment, pregnancies and patient outcomes.
  
  
  RESULTS
  Of the 334 patients, 248 (74%) had been pregnant in some point during their life while 55 (17%) were nulliparous. The history of pregnancies could not be verified in 31 women (9%). Progression of melanoma to advanced stage was found in 58 (17%) of these women. Altogether, 35 women (14%) with at least one pregnancy had disease progression in contrast to 14 women (26%) with no pregnancies (p =0.049). Women with at least one pregnancy had a 94% probability to survive from melanoma compared to nulliparous women of whom only 83% survived (p =0.041). In Multivariate (COX) analysis pregnancy was a favourable factor for disease-specific survival (DSS) (HR 3.75; 95% CI 1.24-11.34; p =0.019) when adjusted for age (HR 1.064; 95% CI 1.00-1.13; p =0.50), localisation and stage (p =0.040), and Breslow (HR 1.32; 95% CI 1.10-1.58; p =0.002). However, when ulceration of the primary tumour was included in the multivariate model, Breslow remained as the only independent predictor of DSS (HR 1.58; 95% CI 1.34-1.86; p =0.0001) and pregnancy was dropped from the stepwise backward model in the step preceding the last one (p =0.081).
  
  
  CONCLUSIONS
  Pregnancy is not a risk factor for disease recurrence or progression in melanoma patients, but instead can exert some favourable influence on prognosis.
authors.affiliation: Department of Oncology and Radiotherapy, Turku University Hospital and University of Turku, Turku, Finland. pia.vihinen@tyks.fi
authors.forename: Pia
authors.initials: P
authors.lastname: Vihinen
authors.forename: Mari
authors.initials: M
authors.lastname: Vainio-Kaila
authors.forename: Lauri
authors.initials: L
authors.lastname: Talve
authors.forename: Ilkka
authors.initials: I
authors.lastname: Koskivuo
authors.forename: Kari
authors.initials: K
authors.lastname: Syrjänen
authors.forename: Seppo
authors.initials: S
authors.lastname: Pyrhönen
mesh_terms: D000293:Adolescent; D000328:Adult; D018450:Disease Progression; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008545:Melanoma / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology; D009367:Neoplasm Staging; D010298:Parity; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology; D015996:Survival Rate; D055815:Young Adult