Illness-related distress in women with clinically localized cutaneous melanoma.

BACKGROUND: Women may experience distress or changes in their quality of life following treatment for early-stage melanoma. In order to plan future interventions and identify areas of primary concern, we conducted a cross-sectional survey to describe the experiences of women treated for clinically localized melanoma. METHODS: We examined quality of life, levels of distress, appearance perceptions, body image, fear of recurrence, and reproductive concerns in 100 patients (age 21-90 years, M = 54.34 years). Most (61 %) had melanoma of the extremity, with a median depth of 1.1 mm (range, 0-10.5 mm). RESULTS: Significant depressive symptomatology occurred in 10 % of patients, and 12 % reported a clinically established high level of intrusive thoughts related to melanoma. Quality-of-life scores indicated more disruption on psychological, compared with social and physical functioning. Also, 64 % of women rated their appearance as worse post-treatment; 23 % were unsatisfied with the appearance of the surgical site. Recurrence concerns indicated significant worry about health and death. Most patients (>85 %) were not concerned about fertility, but 52 % worried that future children would have an increased risk of cancer. CONCLUSIONS: Some women treated for clinically localized melanoma reported high levels of distress associated with their altered body image and fear of recurrence. Improvements in patient education prior to surgical intervention may reduce the distress associated with the diagnosis and treatment of melanoma.

Pregnancy is Not Detrimental to the Melanoma Patient with Clinically Localized Disease.

OBJECTIVE: There exists a strong belief among physicians and the lay public that pregnancy adversely affects survival in patients with melanoma. The authors asked if there was any evidence to support this in patients with clinically localized disease. METHODS: The authors reviewed the published literature on MEDLINE. RESULTS: The authors found no compelling evidence in the literature that pregnancy has a negative impact on survival in patients with clinically localized cutaneous melanoma. Two recent population-based studies reported no negative impact of pregnancy on survival when pregnant melanoma patients were compared to nonpregnant gender-matched controls. A small increased risk of cause-specific death was noted in a recent population-based study, though this effect was small (HR, 1.52, p=0.47) and pregnant patients were more likely to have axial primary sites, which are associated with a poorer outcome. CONCLUSION: There is no compelling evidence that pregnancy adversely affects outcome in melanoma patients who have clinically localized disease. Continuing to recommend a delay in childbearing for these patients is not supported by the published medical literature.