Pregnancy Bliss | Reproductive Health Answers

Previously rare, malignant melanoma is now on a steady increase among young white women. It is a very agressive type of cancer and any changes to a birthmark, however innocuous, should be reported promptly to a doctor.

Malignant melanoma in pregnancy

 

What is malignant melanoma?

This is a type of cancer, usually of the skin but occasionally arising from the eye. It tends to arise from pigmented "birthmarks" but can appear anywhere on the skin surface.

 

 

Why is malignant melanoma especially important in pregnancy?

Firstly, it is relatively common in pregnancy, affecting up to one in every four hundred pregnant women; secondly, it is probably the one malignancy that is definitely known to be adversely affected by pregnancy, being more aggressive at this time; and thirdly, it is one of the very rare forms of cancer which could metastasize (extend to) the placenta and/or the fetus.

 

On a positive note, regression of the cancer can occur following the end of the pregnancy.

 

 

Should a pigmented birthmark be considered for surgical removal before trying to conceive?

It is fair to say that most birthmarks will remain innocent and without any changes throughout life. It is, however, prudent to ask a doctor to look at a birthmark, not only before conception but early in life, to see if it may have potential for malignant transformation.

 

Any changes to such lesions, however innocuous they may seem, require immediate medical attention. Such changes may be an increase in size, a change in shape or colour, or development of irritation/itchiness.

 

There is no time to waste because malignant melanoma can be incredibly aggressive.

 

 

 

 

 

 

 

 

 

What will be the treatment if malignant melanoma is diagnosed in pregnancy?

As in the non-pregnant state, surgery is the mainstay. There is usually no need to terminate the pregnancy. If the disease is discovered at a late stage and surgery is unable to remove the disease entirely, chemotherapy is supplemented. This is not very effective. Radiotherapy is hardly ever useful.

 

What are the prospects offered by BRAF inhibitors for malignant melanoma treatment?

In June 2009, researchers announced results of the first human trial of a drug called PLX4032. This is one of a crop of drugs being developed which are supposed to target a specific genetic mutation of the tumours. In this case it is the so-called BRAF mutation. This approach is radical in the sense that the drugs are supposed to stop the cancer in its tracks regardless of the stage of the disease. About 60% of advanced melanoma are positive for the BRAF mutation. All of a sudden, these patients who are all but guaranteed to die within a few months at best have a promise of possible long term survival. It is very early days but results of the initial human trial have been astonishing. The issue of side-effects and adverse effects in pregnancy are an unknown quantity. Indeed, even the crucial question of whether this drug will make it into use is still unanswered. Here is to hoping.

 

 

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