Non-Gynecologic Tumors and Fertility Melanoma

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.