Melanoma during pregnancy: a report of 60 pregnancies complicated by melanoma

Abstract

The management of melanoma during pregnancy is challenging as maternal benefits and fetal risks need to be balanced. Here, we present an overview of the incidence, the demographic and clinical characteristics and the treatment modalities used. After analysis of obstetric, fetal and maternal outcome, recommendations for clinical practice are provided. From the 'International Network on Cancer, Infertility and Pregnancy' database, pregnant patients with melanoma were identified and analysed. Sixty pregnancies were eligible for analysis. Fifty percent of the patients presented with advanced melanoma during pregnancy (14 stage III and 16 stage IV), and 27% were diagnosed with recurrent melanoma. Surgery was the main therapeutic strategy during pregnancy. Only four patients with advanced melanoma were treated during pregnancy with systemic therapy (n=1) or radiotherapy (n=3). Premature delivery was observed in 18% of the ongoing pregnancies, all which were induced and 78% of which involved patients with advanced melanoma. Thirty-nine percent of the patients died within 5 years; all had been diagnosed with stage III or IV disease during pregnancy. Melanoma can present in a more advanced stage during pregnancy. New systemic therapies may be beneficial for patients with metastatic melanoma but may not be pregnancy compatible. In these patients, preterm induction of labour need to be discussed, despite the short-term and long-term negative effects on the child.

Metastatic melanoma to the ovary in pregnancy: A case report

“…About one third of melanomas in women occur during childbearing age and in Australia, it is the most common malignancy during pregnancy ( Still and Brennecke, 2017 ). In a recent report of 60 patients diagnosed with melanoma during pregnancy, 50% had advanced stage disease with 25% having recurrent disease ( Haan et al, 2017 ). One hypothesis suggest that women of reproductive age may be more susceptible due to higher blood flow to the premenopausal ovary, which may explain the rapid growth of the mass in our patient with increased blood flow in the utero-ovarian vessels with pregnancy.…”

“…Melanoma can present in infants and young children de novo as well, and the majority of cases are de novo, rather than via transplacental origin ( Richardson et al, 2002 ). Congenital melanoma can also present as cutaneous skin lesions or visceral lesions ( Haan et al, 2017 ). In one case report, it presented as lesions in the CNS ( Trumble et al, 2005 ).…”

Melanoma During Pregnancy as a Complicated Medical Problem

“…Melanoma diagnosis in the pregnant woman is not particularly different from that in other patient groups 42 . Any new nevus detected during pregnancy and changes in the nevus regarding color, diameter, symmetry, or border of the lesion require medical evaluation.…”

Cancer during Pregnancy: A Review of Preclinical and Clinical Transplacental Transfer of Anticancer Agents

“…With an incidence ranging from 1 to 2.6 in 10,000 pregnancies [7], melanoma represents 5% of pregnancy-associated cancers [5,6]. The overall incidence has been increasing over the last couple of years, particularly in premenopausal women [34]. Diagnosis is most often made at an advanced stage, possibly due to delayed diagnoses attributable to the tendency for both patients and health workers to address changes in pigmentation as only physiological due to pregnancy.…”

“…Diagnosis is most often made at an advanced stage, possibly due to delayed diagnoses attributable to the tendency for both patients and health workers to address changes in pigmentation as only physiological due to pregnancy. Compared with non-pregnant patients, pregnant women with melanoma do not appear to have a poorer prognosis at identical ages and stages [34,35]. The ESMO clinical practice guidelines recommend identical surgical treatment as for nonpregnant patients [17], and there is no recommendation for systemic treatment during pregnancy.…”