A 36 year old presented at 20 weeks gestation with an abnormal mole. Biopsy revealed a non-ulcerated Stage 1B malignant melanoma with 1.3 mm Breslow thickness and 3.5 mitosis/mm2 (T2a). Lymphoscintigram identified an inguinal sentinel node. She underwent sentinel node biopsy (SNB), wide local excision (WLE) and exicision of the melanoma biopsy scar. She delivered a healthy female infant at 38 weeks with no placental or fetal metastasis. Follow up of the patient over the next 10 months has shown no disease recurrence.
The challenges surrounding melanoma in pregnancy lie in the timing and mode of investigation and treatment. Studies comparing localised melanoma in pregnant and non- pregnant individuals have not identified any differences in stage, tumour thickness, lymph node metastases or survival1. The management of this patient is more aggressive that that advocated in a recent case series in which WLE under local anaesthetic, with SNB postpartum is advocated for second trimester T1b-2b patients.2 No adverse effects to the fetus have been identified following lymphoscintigram3. In conclusion, our data support the use of lymphoscintigram with SNB during pregnancy.
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Broer N, Buonocore S, Goldberg C et al, A proposal for the timing of management of patients with melanoma presenting during pregnancy. J Surg Oncol. 2012 1; 106(1):36–40.
Chakera AH, Hesse B, Burak Z et al, EANM-EORTC general recommendations for sentinel node diagnostics in melanoma Eur J Nucl Med. 2009 36:1713–1742.
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