Management of Melanoma During Pregnancy

Sancy A. Leachman, MD, PhD; Ryan Jackson, HBS; Mark J. Eliason, MD; April A. Larson, MD; Jean L. Bolognia, MD

Disclosures

Dermatology Nursing. 2007;19(2):145-152,161. 

In This Article

Risk to the Fetus

In a comprehensive literature review by Alexander et al. (2003), the authors found that since 1866, only 87 cases of placental or fetal metastasis have been reported. Interestingly, despite the fact that melanoma is not the most common malignancy during pregnancy, it is the most likely to metastasize to the placenta, accounting for 27/87 (31%) of the cases. Fetal metastasis occurred in 6 of the 27 cases, with 5 of these 6 infants succumbing to metastatic disease.

Following delivery, the placenta should be examined both grossly and histologically for signs of metastatic melanoma including appropriate immunohistochemical staining (for example, Melan A, MART-1, S-100 and or HMB-45) (Alexander et al., 2003). It is appropriate to consider performing a baseline chest x-ray, liver function tests, and lactate dehydrogenase level as well as physical exam at birth, followed by a thorough physical examination during each subsequent well-baby visit. Further testing should be performed based on clinical suspicion. Alexander et al. (2003) noted a unique use of low-dose interferon-alpha to treat infants with metastatic disease, but there is insufficient information to make general recommendations regarding adjuvant therapy. In the context of a pregnant woman with stage IV melanoma, parents should understand that although the risk of fetal metastasis is relatively low, if it occurs, the prognosis is exceptionally poor.

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