Choroidal melanoma and pregnancy

Lemaître, S.; Lévy-Gabriel, Christine; Desjardins, Laurence; Plancher, Corine; Asselain, Bernard; Vincent‐Salomon, Anne; Rouic, Livia Lumbroso‐Le; Dendale, R.; Rouzier, Roman; Delacroix, S.; Cassoux, Nathalie

doi:10.1111/aos.12984

Cited by 9 publications

(25 citation statements)

References 33 publications

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“…Three studies reported no significant difference between the 5-year survival and 5-year metastasis-free survival rates between nonpregnant women with UM and pregnant women with UM [4, 45, 46]. These 3 case-control studies investigate a total of 61 pregnant patients and agree in their findings providing level 3 evidence that pregnancy does not affect prognosis of UM.…”

Section: Evidence For Sex Hormone Receptor Expression In Nevi/um Tumorsmentioning

confidence: 78%

“…Lemaitre et al [46] compared 26 pregnant UM patients to 524 total UM patients of childbearing age at their institution from 1980 to 2013. There was no difference in survival between the 4 groups of patients (pregnant at time of diagnosis, pregnancy 2 years before diagnosis, pregnancy after prior treatment, and no recorded pregnancy), neither in overall survival nor metastasis-free survival [46].…”

Section: Evidence For Sex Hormone Receptor Expression In Nevi/um Tumorsmentioning

confidence: 99%

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Is Uveal Melanoma a Hormonally Sensitive Cancer? A Review of the Impact of Sex Hormones and Pregnancy on Uveal Melanoma

Miller¹,

Schoenfield²,

Abdel-Rahman³

et al. 2021

Ocul Oncol Pathol

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Background: Despite a higher incidence and worse prognosis of uveal melanoma (UM) in men, there have been many case reports of pregnant patients with aggressive UM. This has led researchers to explore the influence of sex hormones and pregnancy on the development and progression of UM and hormones as potential therapeutic targets. Summary: A systematic literature review was conducted. More work is needed to elucidate the basis of sex differences in UM incidence and survival. The evaluation of germline BAP1 mutation would be beneficial in patients with UM presenting at a young age. Importantly, multiple studies reported no significant difference between the 5-year survival and 5-year metastasis-free survival rates between nonpregnant women with UM and pregnant women with UM. Multiple case-control studies disagree on how parity affects risk of UM. However, most studies agree that oral contraceptives and hormone replacement therapy have no effect on the incidence of UM. Current treatment strategies for pregnant patients with UM are discussed. Looking forward, this review reports recent research on targeted receptor-based chemotherapy, which is based on evidence of estrogen receptor (ER), estrogen-related receptor alpha (ERRα), and luteinizing hormone-releasing hormone (LHRH) receptor expression in UM. Key Messages: Based on review of the literature, UM is not a contraindication to oral contraceptives, hormone replacement therapy, or pregnancy. Globe-sparing radiation can be used as a treatment option for pregnant patients. Due to the presence of ER on a subset of unselected UM, its potential for adjunctive targeted therapy with agents like tamoxifen should be explored. Lessons from cutaneous melanoma regarding tissue ratios of estrogen receptors (ERα:ERβ) should be applied to assess their therapeutic predictive value. In addition, ERRα-targeted therapeutics and LHRH analogs are worthy of further exploration in UM.

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Section: Evidence For Sex Hormone Receptor Expression In Nevi/um Tumorsmentioning

confidence: 78%

Section: Evidence For Sex Hormone Receptor Expression In Nevi/um Tumorsmentioning

confidence: 99%

Is Uveal Melanoma a Hormonally Sensitive Cancer? A Review of the Impact of Sex Hormones and Pregnancy on Uveal Melanoma

Miller¹,

Schoenfield²,

Abdel-Rahman³

et al. 2021

Ocul Oncol Pathol

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“…No health effects following exposure in utero have been noted for doses < 50 mSv, which is 10 times higher than the allowable dose of 5 mSv during gestation. Only 1 reported dose from this cohort of female ocular oncologists was higher than the gestational limit, and all were less than the body dose of 50 mSv [16]. While there is theoretical concern about fetal exposure in surgeons, pregnant women who have required brachytherapy have been reported, and there have been no radiation-related issues to the fetus [16, 17].…”

Section: Discussionmentioning

confidence: 99%

“…Only 1 reported dose from this cohort of female ocular oncologists was higher than the gestational limit, and all were less than the body dose of 50 mSv [16]. While there is theoretical concern about fetal exposure in surgeons, pregnant women who have required brachytherapy have been reported, and there have been no radiation-related issues to the fetus [16, 17]. Nonetheless, this is a very small cohort of women with reported fetal exposure, and the health effects of very low-dose radiation remain an area of hot controversy.…”

Section: Discussionmentioning

confidence: 99%

Trends in Radiation Practices for Female Ocular Oncologists in North America: A Collaborative Study of the International Society of Ocular Oncology

et al. 2018

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Background: The aim of this study was to determine the known radiation exposure, attitudes, and consequent risk modifications among female ocular oncologists in North America who routinely administer radioactive plaque brachytherapy treatment and are members of the International Society of Ocular Oncology. Methods: Nineteen female ocular oncologists completed an anonymous 17-question radiation exposure survey. Results: Eleven of the participants chose to routinely wear lead protection during surgery; 8 did not. Fifteen of 19 participants reported using an unloaded “nonactive” template to prepare for plaque implantation. During pregnancy, 11 of 13 participants continued to perform plaque brachytherapy. Eight of these 11 undertook measures to decrease radiation exposure self-reported as lead wear and other. The average reported anxiety regarding fertility was 2.1 (SD, 2.2) on a scale from 1 to 10. Conclusion: This study corroborates prior literature that surgeons’ exposure to radiation during plaque brachytherapy is minimal. Nonetheless, there remains some anxiety regarding exposure risk to women, due to potential effects on fertility and fetal health. We found variability in exposure monitoring, required training, and precautions during pregnancy amongst this group of surgeons. Improved education and clearer pregnancy guidelines may equip female ocular oncologists with optimal knowledge regarding risk of radiation exposure.

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“…A few reports have documented rapid growth during pregnancy [22,23], but a recent case series of 27 pregnant women did not find any difference in survival among these women when compared to controls [24]. …”

Section: Discussionmentioning

confidence: 99%

Conjunctival Melanoma during Pregnancy

et al. 2016

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Purpose: To describe the clinical and histopathological features of a conjunctival melanoma (CM) during early pregnancy. Procedures: A 37-year-old, 20-week pregnant primigravida was referred to the Sheffield Ocular Oncology Service with a rapidly growing lesion arising from the right superior conjunctival fornix, noted from the first trimester of pregnancy. This was associated with pain and bloody discharge. Incisional biopsy confirmed the clinical suspicion of invasive CM. She was treated by primary surgical excision and cryotherapy under local anaesthesia. Results: Histology of the excised specimen showed an invasive malignant melanoma with surrounding in situ conjunctival changes arising from a naevus. The melanoma was 10.5 mm thick, focally necrotic, and had a mitotic count of 11/mm² focally. The patient responded well to surgical treatment. She gave birth to a healthy boy, and the placenta showed no evidence of metastatic melanoma. There has been no recurrence or distant metastasis during 5 years of follow-up. Conclusion: CM during pregnancy is extremely rare. Because of possible transformation to malignant melanoma, we recommend close monitoring of females known to have pigmented conjunctival lesions of the conjunctiva during pregnancy.

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Choroidal melanoma and pregnancy

Abstract: Survival in women of childbearing age does not appear to be influenced by pregnancy. We show that proton beam therapy can be used to treat women who are pregnant at the time of choroidal melanoma diagnosis.

Cited by 9 publications

References 33 publications

Is Uveal Melanoma a Hormonally Sensitive Cancer? A Review of the Impact of Sex Hormones and Pregnancy on Uveal Melanoma

Is Uveal Melanoma a Hormonally Sensitive Cancer? A Review of the Impact of Sex Hormones and Pregnancy on Uveal Melanoma

Trends in Radiation Practices for Female Ocular Oncologists in North America: A Collaborative Study of the International Society of Ocular Oncology

Conjunctival Melanoma during Pregnancy

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