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

Conclusions

The rates of melanoma incidence and average maternal age are rising and clinicians will increasingly be confronted with the management of pregnant patients with melanoma. Recent in vitro studies and analytic reviews of the effects of birth control and hormonal replacement therapy on the incidence of melanoma do not support the assertion that sex hormones significantly effect the development or progression of melanoma. The actual number of melanocytic nevi that transform during pregnancy is quite small, but any change should be approached with at least the same suspicion as in a nonpregnant patient. To date, no controlled studies have shown a significant difference in 5-year survival rates when pregnant and nonpregnant melanoma patients are compared. For early stage (I or II) disease, the clinician should approach treatment the same as in a nonpregnant patient. A SLN biopsy can be done relatively safely, and the procedure can be considered in pregnant patients when the prognostic benefit to the couple is felt to outweigh the risks. Clinicians may consider avoiding the use of isosulfan blue or other dyes due to the increased risk for anaphylaxis.

Surgical excision remains the only effective treatment for melanoma. Terminating a pregnancy does not, by itself, affect the outcome of a melanoma in the mother. Metastasis to the placenta or fetus of any cancer is a very rare event (87 reported cases in the last 140 years). However, melanoma appears the most likely cancer to metastasize, making up 31% of these 87 cases. A thorough examination of the placenta and baby at the time of birth for signs of malignancy can identify disease. However, the treatment options for fetal metastasis remain limited and largely ineffective. Following treatment for melanoma, health care providers should base their recommendations regarding the time interval prior to the next pregnancies on the stage of the melanoma and age of the patient.

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