Melanoma is diagnosed within a wide range of ages, beginning in the third
decade of life: it occurs slightly more commonly in women younger than 40, and
represents the second most frequently diagnosed malignant tumor in patients 15 to 29
years of age. The overall incidence of melanoma in pregnancy is about 0.14 to 0.28
cases per 1000 births, accounting for 8% of malignancies diagnosed during pregnancy;
although occurring extremely rarely; melanoma is one of the most common tumors
known to metastasize to the placenta and the fetus.
From the recent literature, we can conclude that chest radiography with radiation
protection and abdominal ultrasounds are safe; Computed Tomography (CT) with
intravenous contrast and positron emission tomography are generally contraindicating
because of emission of high dose of radiation; Magnetic Resonance (MR) is safer than
CT, but it is contraindicated during 1st trimester of pregnancy because it employs heart
tissues and exposes the fetus to excessive noise than can cause high-frequency hearing
loss in neonates.
There is no conclusive evidence that pregnancy significantly affects melanoma
aggressiveness in terms of increasing metastases incidence or lowering overall survival.
Two recent investigations have reported increased mortality in women with pregnancyassociated malignant melanoma. Some data suggest that increased mortality of the
melanoma patients with recent childbirth is mainly due to a stage-independent causal
pathway: the pregnancy-associated immune suppression may permit some melanomas
with high malignant potential to progress and come to clinical diagnosis in the short
term following childbirth. However, some other data analysis shows no difference in
tumour location and stage at diagnosis between women with PAMM and non-PAMM;
furthermore, no evidence of a worse prognosis was found in women given the
diagnosis of PAMM. Given these results, the authors conclude that counselling and
monitoring women with PAMM do not need to be different from those provided for
women with non-PPAMM. The main goals of melanoma treatment during pregnancy
are to cure the neoplasia and avoid complications for the fetus; irrespective of
pregnancy status, wide local excision around the melanoma site with margins
proportional to the microstage of the primary lesion, is the treatment oflocalized
melanomas. In more advanced cases (>4mm depth), adjuvant therapy with high dose interferon
must be considered; although interferon is safely administered in pregnant patients with
haematological malignancies, adjuvant therapy with high dose interferon has not been
studied in pregnancy associated melanoma and therefore is not routinely recommended.
Keywords: Chemotherapy, CT, Fetus, Melanoma, Microstage, Pregnancy, RMN, Radiotherapy, Survival.
