You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.


Endometriosis Linked to Increased Risk for Melanoma

  • Authors: News Author: Laurie Barclay, MD
    CME Author:
    Désirée Lie, MD, MSEd
  • CME / CE Released: 10/30/2007
  • Valid for credit through: 10/30/2008
Start Activity

Target Audience and Goal Statement

This article is intended for primary care clinicians, dermatologists, gynecologists, and other specialists who care for women.

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  1. Describe the association between endometriosis and melanoma.
  2. Describe the association of benign gynecologic conditions with melanoma.


As an organization accredited by the ACCME, Medscape, LLC requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


  • Laurie Barclay, MD

    Laurie Barclay is a freelance reviewer and writer for Medscape.


    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.


  • Brande Nicole Martin

    Brande Nicole Martin is the News CME editor for Medscape Medical News.


    Disclosure: Brande Nicole Martin has disclosed no relevant financial information.

CME Author(s)

  • Désirée Lie, MD, MSEd

    Clinical Professor, Family Medicine, University of California, Orange; Director, Division of Faculty Development, UCI Medical Center, Orange, California


    Disclosure: Désirée Lie, MD, MSEd, has disclosed no relevant financial relationships.

Accreditation Statements

    For Physicians

  • Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    Medscape, LLC designates this educational activity for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should only claim credit commensurate with the extent of their participation in the activity. Medscape Medical News has been reviewed and is acceptable for up to 300 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins 09/01/07. Term of approval is for 1 year from this date. This activity is approved for 0.25 Prescribed credits. Credit may be claimed for 1 year from the date of this activity. AAFP credit is subject to change based on topic selection throughout the accreditation year.

    AAFP Accreditation Questions

    Contact This Provider

    For Nurses

  • This Activity is sponsored by Medscape Continuing Education Provider Unit.

    Medscape is an approved provider of continuing nursing education by the New York State Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation.

    Awarded 0.25 contact hour(s) of continuing nursing education for RNs and APNs; None of these credits is in the area of pharmacology.

    Provider Number: 6FDKKC-PRV-05

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. Medscape encourages you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 5 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.

*The credit that you receive is based on your user profile.


Endometriosis Linked to Increased Risk for Melanoma

Authors: News Author: Laurie Barclay, MD CME Author: Désirée Lie, MD, MSEdFaculty and Disclosures

CME / CE Released: 10/30/2007

Valid for credit through: 10/30/2008


October 30, 2007 — Endometriosis increased the risk for melanoma, according to the results of a large, prospective French cohort study reported in the October 22 issue of the Archives of Internal Medicine.

"An association between melanoma and endometriosis has been reported, but most findings relied on case-control studies or a limited number of melanoma cases, and therefore the available evidence is weak," write Marina Kvaskoff, MPH, from Institut National de la Santé et de la Recherche Médicale and Institut Gustave Roussy in Villejuif, France, and colleagues. "Moreover, the effect of other benign gynecological diseases on melanoma risk is unknown."

The Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l'Education Nationale cohort includes 98,995 French women, insured by a national health scheme mostly covering teachers, who were aged 40 to 65 years at enrollment. Beginning in 1990, the investigators regularly collected data on history of endometriosis and other benign gynecologic diseases, and they calculated relative risks (RRs) using Cox proportional hazards regression models.

Of 91,965 women followed up for 12 years, 5949 had a history of endometriosis, and 363 were diagnosed with melanoma during follow-up. History of endometriosis was a significant risk factor for development of melanoma (RR, 1.62; 95% confidence interval [CI], 1.15 - 2.29).

Women with a history of fibroma (n = 24,375) also had a significantly increased risk for melanoma vs those with no such history (RR, 1.33; 95% CI, 1.06 - 1.67). However, ovarian cysts, uterine polyps, breast adenoma/fibroadenoma, and breast fibrocystic disease were not significant predictors of melanoma.

"These data provide the strongest evidence to date of a positive association between a history of endometriosis and melanoma risk," the study authors write. "The association between fibroma and melanoma, which has not been previously described, warrants further investigation."

Limitations of the study include possible misclassification bias, lack of data on specific types of drugs used as hormonal treatment for the studied gynecologic conditions, study cohort being predominantly female teachers with high levels of education and socioeconomic status, lack of data on sun exposure and sunburn history, and possible unknown residual confounders.

"Endometriosis is an important women's health issue worldwide," the study authors conclude. "Because this disease appears to be a risk indicator for cutaneous melanoma, gynecologists may play a role in melanoma prevention by alerting patients with endometriosis of their higher susceptibility to the disease."

The French League Against Cancer, the European Community, the 3M Company, the Mutuelle Générale de l'Education Nationale, the Institut Gustave Roussy, the Institut National de la Santé et de la Recherche Médicale, and the Fondation de France supported this study. Some of the study authors have disclosed relevant financial relationships.

Arch Intern Med. 2007;167:2061-2065.

Clinical Context

An unexpected association has been found between melanoma and a history of endometriosis in 3 previous cohort studies, and a retrospective cohort study of women with infertility found an increased risk for melanoma. Some reproductive factors may be associated with both endometriosis and melanoma because nulliparity and pauciparity have been associated with melanoma, and the risk for melanoma has been observed to be lower among women with high parity and earlier age at first pregnancy.

This is a prospective cohort study of French women in a national health insurance scheme who were followed up for nearly 12 years to examine the association between benign gynecologic conditions and the risk for melanoma.

Study Highlights

  • Included were 98,995 women aged 40 to 65 years at baseline, who were primarily teachers covered by a national health insurance scheme, were enrolled for a 2-year period, and who completed a baseline questionnaire.
  • Excluded were women with a preexisting cancer (except basal cell carcinoma), those lost to follow-up, and those who had never menstruated.
  • Women completed follow-up questionnaires every 2 years, which addressed medical events including cancer and benign gynecologic diseases.
  • Information on age at menarche, parity, body mass index (BMI), duration of menstrual cycles, and infertility treatments were obtained.
  • Benign gynecologic diseases were defined as those treated or diagnosed via a specific diagnostic procedure; for all conditions, type of treatment was described.
  • A positive exposure of a benign gynecologic condition included conditions diagnosed by laparoscopy, biopsy, hysterography, hysteroscopy, or ultrasonography.
  • Ovarian cysts occurring with endometriosis were not separately considered.
  • Cox proportional hazard regression models were used to derive RRs.
  • During follow-up, a total of 363 melanoma cases were ascertained among 91,965 women, and pathology reports were available for 97.8% of melanoma cases.
  • Median follow-up was 12 years.
  • 84% of women had a BMI at baseline of 25 kg/m 2 or less, 60% had chestnut-colored hair, 18% were blond, and 13% had brown hair.
  • 38% were highly sensitive to sun exposure, and 46% were moderately sensitive to sun exposure.
  • 24% had very many nevi and 9% had very many freckles.
  • Women with melanoma were significantly more likely to have blond, red, or chestnut hair, as expected, and a high sensitivity to sun exposure with a larger number of freckles and nevi.
  • Educational level and BMI were not correlated with melanoma risk.
  • A personal history of endometriosis (n = 5949) was associated with an increased risk for melanoma (RR, 1.62; 95% CI, 1.15 - 2.29).
  • A significantly increased risk for melanoma was found for women with a personal history of uterine fibroma (n = 24,375) vs those with no such history (RR, 1.33; 95% CI, 1.06 - 1.67).
  • A history of ovarian cysts, uterine polyps, breast adenoma/fibroadenoma, or breast fibrocystic disease was not significantly associated with melanoma risk.
  • Adjustment for infertility treatment, progestagen use, hormone use, parity, and menopausal status did not change the results.
  • There was a significant association between endometriosis and red hair ( P = .02).
  • The association between red hair and endometriosis and melanoma risk was not significant.
  • In this cohort, nulliparity was not associated with melanoma risk.
  • The authors concluded that this prospective study provided strong evidence of a link between a personal history of endometriosis and cutaneous melanoma.

Pearls for Practice

  • A personal history of endometriosis or uterine fibroma is associated with higher risk for cutaneous melanoma in women.
  • A history of ovarian cysts, uterine polyps, breast adenoma/fibroadenoma, or breast fibrocystic disease is not significantly associated with melanoma risk.


  • Print