Melanoma During Pregnancy: Clinical Outcomes, Therapeutic Decision-Making, and Ethical–Medico-Legal Challenges—A Systematic Review

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Background: Pregnancy-associated melanoma requires integration of maternal cancer prognosis with treatment, obstetric and fetal considerations. Methods: PubMed/MEDLINE and OpenAlex searches were supplemented with Scopus and Web of Science Core Collection through 15 October 2026. The four export sets yielded 3460 records; conservative DOI/title deduplication retained 2642 unique records, after independent adjudication of 21 discordant-identifier groups. In accordance with the authors’ eligibility decisions, 16 publications (12 original and four newly identified observational studies) were retained for a narrative synthesis. Results: Davidson et al. reported comparable five-year overall survival in 83 pregnancy-associated melanoma patients and 309 matched controls (97% versus 97%). Kostaki et al. described 70 pregnancy-associated melanomas within a 1270-woman European cohort, with a mean Breslow thickness of 1.16 mm and five-year recurrence-free survival of 95%. Grippaudo et al. reported multidisciplinary surgical management in 20 pregnant patients. Borgers et al. described 72 women with advanced melanoma across two partly overlapping pregnancy-related groups, illustrating high maternal and perinatal risks and variation in treatment timing. Conclusions: Pregnancy itself is not consistently associated with adverse melanoma prognosis after accounting for disease characteristics, whereas treatment safety in gestation remains insufficiently established. Stage-specific, multidisciplinary and autonomy-respecting decisions are required; the evidence remains heterogeneous and registry populations must not be counted twice.