Melanoma in pregnancy: a case report and review of the literature

Malignant melanoma is one of the most rapidly growing neoplasms that develop during pregnancy. Traditionally, it has been stated that women who are pregnant at the time of diagnosis have a poorer prognosis than women who are not pregnant. Additionally, the subsequent pregnancies were believed to increase the recurrence rate. There are very few studies in this area, but some authors of retrospective studies show that gestating women have poorer prognosis than non-pregnant women. Other authors report the presence of sex-hormone receptors in the melanoma tissue, suggesting a hormonal sensitivity of this neoplasm. There is also a group of studies that do not confirm these findings.
A 32-year-old healthy patient reported to the Gynaecology Clinic, Jagiellonian University Medical College (JUMC) in her twenty-first week of gestation with a verrucous lesion on the back in the interscapular area. The patient was consulted at the Outpatient Clinic of the Department of Dermatology, JUMC. A melanocytic nevus, often irritated by the patient, was described. There were neither clinical nor dermoscopic features of an underlying neoplastic process, so photo-documentation was not performed at that time. The patient did not report any other illnesses or symptoms, and she did not take any medication. The pregnancy was endangered, so the patient decided to postpone the surgical excision of the lesion after giving birth. Five months later, the patient returned to the Clinic with a noticeably enlarged (now 3 × 2 cm), polypous, ulcerated tumour. An excisional biopsy of the lesion was made – with a macroscopic margin of 10 mm. The patient received chloramphenicol ointment, and dressings were applied. Histologically, the lesion was described as malignant melanoma, nodular type with ulceration. The neoplasm was in the vertical phase of growth, Clarke V, Breslow IV with mitotic activity of 14 mitotic figures/mm². Features of vascular invasion were observed on the basis of the lesion. In the dermis and subcutaneous area, numerous microsatellite foci were found, with the greatest being 2.2 mm in size. The lesion was removed with microscopic borders of 1.2 mm and 4 mm laterally and 6.5 mm deep. Abdominal ultrasound revealed hypo- and hyperechoic lesions in the liver (max. size: 47 × 29 × 36 mm) and hypoechoic lesions in the spleen with a single enlarged lymph node near the head of the pancreas (16 × 7 mm). Nuclear magnetic resonance (NMR) confirmed hypo- and...


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