title: Melanoma during pregnancy: a report of 60 pregnancies complicated by melanoma.
abstract: The management of melanoma during pregnancy is challenging as maternal benefits and fetal risks need to be balanced. Here, we present an overview of the incidence, the demographic and clinical characteristics and the treatment modalities used. After analysis of obstetric, fetal and maternal outcome, recommendations for clinical practice are provided. From the 'International Network on Cancer, Infertility and Pregnancy' database, pregnant patients with melanoma were identified and analysed. Sixty pregnancies were eligible for analysis. Fifty percent of the patients presented with advanced melanoma during pregnancy (14 stage III and 16 stage IV), and 27% were diagnosed with recurrent melanoma. Surgery was the main therapeutic strategy during pregnancy. Only four patients with advanced melanoma were treated during pregnancy with systemic therapy (n=1) or radiotherapy (n=3). Premature delivery was observed in 18% of the ongoing pregnancies, all which were induced and 78% of which involved patients with advanced melanoma. Thirty-nine percent of the patients died within 5 years; all had been diagnosed with stage III or IV disease during pregnancy. Melanoma can present in a more advanced stage during pregnancy. New systemic therapies may be beneficial for patients with metastatic melanoma but may not be pregnancy compatible. In these patients, preterm induction of labour need to be discussed, despite the short-term and long-term negative effects on the child.
authors.affiliation: Departments of aOncology bReproduction and Regeneration, KU Leuven cDepartment of Obstetrics and Gynaecology dDivision of Gynaecologic Oncology, University Hospitals Leuven, Leuven eDepartment of Medical Oncology, Breast Cancer and Gynecological Oncology Unit, Antwerp University Hospital, Edegem, Belgium fDepartment of Obstetrics and Gynaecology, VU University Medical Center gDepartment of Gynaecologic Oncology, Center for Gynaecologic Oncology hDepartment of Dermatology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam iDepartment of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam jDepartment of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands kDepartment of Clinical Oncology, Vejle Hospital, Vejle lInstitute of Regional Health Research, University of Southern Denmark, Odense, Denmark mDepartment of Obstetrics and Gynaecology, 2nd Medical Faculty, Charles University, Prague, Czech Republic nDivision of Obstetrics and Gynaecology, San Gerardo Hospital, University of Milan-Bicocca, Monza, Italy oDepartment of Obstetrics and Gynaecology, University Hospital, Krakòw, Poland.
authors.forename: Jorine
authors.initials: J
authors.lastname: de Haan
authors.forename: Christianne A
authors.initials: CA
authors.lastname: Lok
authors.forename: Christianne J
authors.initials: CJ
authors.lastname: de Groot
authors.forename: Marianne B
authors.initials: MB
authors.lastname: Crijns
authors.forename: Kristel
authors.initials: K
authors.lastname: Van Calsteren
authors.forename: Karina
authors.initials: K
authors.lastname: Dahl Steffensen
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Halaska
authors.forename: Sevilay
authors.initials: S
authors.lastname: Altintas
authors.forename: Ingrid A
authors.initials: IA
authors.lastname: Boere
authors.forename: Robert
authors.initials: R
authors.lastname: Fruscio
authors.forename: Wojciech
authors.initials: W
authors.lastname: Kolawa
authors.forename: Petronella O
authors.initials: PO
authors.lastname: Witteveen
authors.forename: Frédéric
authors.initials: F
authors.lastname: Amant
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008545:Melanoma / Q000150:complications / Q000473:pathology* / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000473:pathology* / Q000601:surgery; D011256:Pregnancy Outcome; D015996:Survival Rate; D055815:Young Adult