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Soo Park, MD
Soo Park, MD
Posted: Wednesday, June 5, 2024
Ashley Hickman, MD, of the Mayo Clinic, Rochester, Minnesota, and colleagues have found that melanoma diagnosed during pregnancy may be safely and effectively staged with sentinel lymph node surgery, MRI imaging (PET/MRI vs standard), and CT imaging with shielding—possibly avoiding both early induction of labor and a delay in cancer care for pregnant patients. The team also highlighted a patient with stage IV disease who was treated with vemurafenib during pregnancy and immunotherapy after, suggesting this may be a viable approach for treating stage IV pregnancy-associated melanoma with systemic therapy. Their findings were presented as part of the 2024 American Society for Clinical Oncology (ASCO) Annual Meeting (Abstract e21554).
“Antepartum evaluation of melanoma must incorporate both maternal and fetal factors, and currently there is lack of standardization,” the researchers stated. “Our study aimed to review the incidence of antepartum melanoma at our institution and highlight patterns in management and treatment during this high-risk scenario.”
A total of 19 patients diagnosed with melanoma during pregnancy between 1987 and 2023 were included in the study. The average maternal and gestational ages at diagnosis were 30 (range: 24–38 years) and 20 (range: 6–35 weeks), respectively. All patients had term deliveries.
The investigators reported workup, treatment, and outcomes by stage, observing that 60% of patients had a delay in imaging or treatment attributed to pregnancy, and four underwent labor induction at 37 weeks for staging/treatment. They also noted 82% of patients with stage I to III disease underwent wide local excision during pregnancy, but 35% of sentinel lymph node sampling was delayed until postpartum. A total of 7 of the 19 patients had subsequent pregnancies, one of whom had a recurrence of melanoma during her second pregnancy (stage II followed by stage IV). Finally, the investigators noted that because of few censoring events, median progression-free survival and overall survival were not reached.
Disclosure: For full disclosures of the study authors, visit coi.asco.org.
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