Pregnancy-associated melanoma epidemiology: A multicentre European study.
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BACKGROUND: Melanoma is the most common malignancy during pregnancy, with incidence rates rising globally. While most studies focus on prognosis, limited data exist on melanoma in the early post-partum period. OBJECTIVES: This multicentre European study aimed to characterize the epidemiologic and clinicopathologic features of pregnancy-associated melanoma (PAM) and assess whether these tumours differ from melanomas not associated with pregnancy. METHODS: We identified 1,270 women of reproductive age (15-49 years) diagnosed with melanoma between 2012 and 2022 across six melanoma centres in five European countries. RESULTS: Among them, 70 cases (5.5%) were classified as PAM (range: 1.2%-14.3%). Compared to non-PAM patients, women with PAM were younger (mean age 35.7 years; p < 0.001) and more likely to have a high nevus count (p = 0.031). The majority of PAMs (80.0%) were superficial spreading, and mean Breslow thickness was 1.16 mm; 12.9% were ulcerated. Notably, 57.1% developed on a pre-existing nevus. Histopathologic features were similar between groups, except for tumour-infiltrating lymphocytes (TILs): non-PAM tumours exhibited significantly more dense TILs (p = 0.012), possibly indicating a stronger immune response. Median follow-up was 5.5 years. Recurrence-free survival did not significantly differ between groups; the 5-year recurrence-free survival rate was 95%. CONCLUSIONS: Although pregnancy does not appear to adversely impact melanoma prognosis, PAM demonstrates some distinct clinical features that warrant further investigation given the fact that it affects a substantial proportion of women of reproductive age diagnosed with melanoma. The frequent occurrence of PAM on pre-existing nevi highlights the importance of raising public awareness and promoting dermatologic evaluation of suspicious lesions during pregnancy.