Effects of Oral Contraceptives and Pregnancy on Melanomas

The action of estrogens testosterone and progesterone and the role of pregnancy in primary or metastatic melanoma are not clear. There is no evidence that steroidal hormones or pregnancy participate in the conversion of a benign pigmental lesion into a melanoma or the acceleration of metastases from a primary melanoma. Shiu et al. found that pregnancy had an adverse effect on women who already had metastases. Nevertheless there are reports of four women whose melanomas either began or metastasized after they were placed on estrogens or progesterone (or both) for symptoms of menopause or for birth control. Moreover Sadoff et al. reported on two men who had melanoma after taking stilbestrol for prostatic cancer. We wish to report on three additional patients. A 13-year-old girl had a Grade III superficial spreading melanoma removed from her back. There was no further evidence of the melanoma until eight months after she started taking an anovulatory drug at 19 years of age. She later had metastatic lesions. Another woman had a nevus of Ota present from birth. Two years after she started using oral contraceptives a melanoma developed in the nevus. Both patients died from metastases. The third patient a 31-year-old woman with a congenital interscapular nevus noted enlargement ulceration and bleeding of the nevus during the last trimester of pregnancy. After delivery the lesion regressed and remained quiescent for two years. Now she has regional metastases. Lopez et al. recently suggested that estrogens accelerate the growth of melanomas in mice. Physicians should report on patients who later show melanomas and those who already have melanomas if their clinical courses change after taking estrogens androgens or progesterone of if they become pregnant. Until more data are available women who have been operated on for removal of primary melanomas should avoid taking anovulatory agents. (FULL-TEXT)