Health & Medical Skin Conditions & Dermatology

Management and Outcome of Metastatic Melanoma During Pregnancy

Management and Outcome of Metastatic Melanoma During Pregnancy

Abstract and Introduction

Abstract


Background Although metastatic melanoma occurrence during pregnancy challenges the physician in several ways, only a few studies have been published.
Objectives Our aim was to investigate therapeutic management together with maternal and fetal outcomes in pregnant women with advanced melanoma.
Methods A French national retrospective study was conducted in 34 departments of Dermatology or Oncology. All patients with American Joint Committee on Cancer (AJCC) stage III/IV melanoma diagnosed during pregnancy were included. Data regarding melanoma history, pregnancy, treatment, delivery, maternal and infant outcomes were collected.
Results Twenty-two women were included: 10 AJCC stage III and 12 stage IV. Abortion was performed in three patients. Therapeutic abstention during pregnancy was observed in three cases, 14 patients underwent surgery, four patients received chemotherapy and one patient was treated with brain radiotherapy alone. The median gestational age was 36 weeks amenorrhoea. Neither neonatal metastases nor deformities were observed. Placenta metastases were found in one case. Among 18 newborns, 17 are currently alive (median follow up, 17 months); one died of sudden infant death. The 2-year maternal survival rates were 56% (stage III) and 17% (stage IV).
Conclusions Faced with metastatic melanoma, a majority of women chose to continue with pregnancy, giving birth, based on our samples, to healthy, frequently premature infants. Except during the first trimester of pregnancy, conventional melanoma treatment was applied. No serious side effect was reported, except one case of miscarriage after surgery. Mortality rates do not suggest a worsened prognosis due to pregnancy but larger prospective controlled studies are necessary to assess this specific point.

Introduction


Cancer during pregnancy is a rare situation, since its occurrence has been estimated as 1 pregnancy out of 1000. The malignancies most frequently involved are those affecting young people of childbearing age. As an illustration, melanoma is the most common malignancy occurring in women aged from 25 to 29 years, and it accounts for about eight percent of all malignant tumours arising during gestation, after cervical and breast cancers and before leukaemia and lymphoma.

Knowledge about melanoma occurring during pregnancy is rather poor and contentious. It has long been thought that pregnancy was associated with a worse prognosis for primary melanoma, but several recent large epidemiological studies have ruled out this assumption. Although a large number of isolated cases have been published, metastatic melanoma in pregnant women is still a non-codified situation. The main interest of these publications is to report the possibility of placental metastases during visceral metastatic melanoma, with a secondary risk for metastases in the fetus resulting most of the time in a fatal outcome. Furthermore, studies on clinical practice are lacking and current practice patterns remain widely unknown. The lack of data available about both the maternal and the fetal outcomes prompted us to conduct a multicentre retrospective descriptive and explanatory analysis of most aspects of the management of metastatic melanoma diagnosed during pregnancy.

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