DS22 Pregnancy-associated melanoma: a case series

Abstract

Abstract There are currently no guidelines in the UK regarding the management of pregnancy-associated melanoma (PAM). It is estimated that one-third of women diagnosed with melanoma are of child-bearing age and numbers are rising (Still R, Brennecke S. Melanoma in pregnancy. Obstet Med 2017; 10:107–12). A recent survey of all dermatologists in our region revealed five cases of PAM. We await the results of a similar survey disseminated to all UK dermatologists. Case 1 was a 22-year-old woman of 16 weeks’ gestation who presented with a 6-week history of a changing mole on her face. Histology confirmed a nodular malignant melanoma [Breslow thickness (BT) 3.5 mm]. A healthy baby was born at full term. Case 2 was a 36-year-old nulliparous woman who presented with a changing lesion on her right calf. Histology confirmed a malignant melanoma (BT 3.6 mm). At the 2-week follow-up, she was 4 weeks pregnant. A healthy baby was born at 38 weeks. Case 3 was a 33-year-old nulliparous woman who had a superficial spreading malignant melanoma (BT 2 mm) excised from her left scapula. Twenty-three months after this diagnosis, pulmonary metastases were evident on computed tomography (CT). Three months later, she became pregnant. A healthy baby was born at term. Case 4 was a 30-year-old nulliparous woman who had a malignant melanoma (BT 3 mm) excised from her right scapula. A sentinel lymph node biopsy (SLNB) was negative, and staging CT showed no evidence of metastatic disease. She received a course of interferon treatment. Three years after initial presentation, at 24 weeks’ gestation, she developed a painful swelling on her right axilla that was confirmed to be metastatic melanoma. A healthy baby was born at 35 weeks. Case 5 was a 27-year-old woman who had a melanocytic lesion that was shave excised by her general practitioner. Subsequent excision confirmed superficial spreading malignant melanoma (BT 1.5 mm, stage 1B). At the time of wide local excision and SLNB 1 month later, the patient was 6/40 gestation. Sentinel lymph node biopsy was negative so no further staging scans were required. A healthy baby was born at term. There are conflicting data on whether PAM carries a poorer prognosis than equivalent disease in nonpregnant women. However, melanoma is one of several cancers that can metastasize to the placenta. Therefore, a diagnosis of PAM complicates decisions regarding staging and treatment (Carter TJ, George C, Harwood C, Nathan P. Melanoma in pregnancy: diagnosis and management in early-stage and advanced disease. Eur J Cancer 2022; 166:240–53).