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Re: Is pregnancy safe for a melanoma patient post treatment?

Forums General Melanoma Community Is pregnancy safe for a melanoma patient post treatment? Re: Is pregnancy safe for a melanoma patient post treatment?

    FertilityDoc
    Participant

      I gathered some iformation for you from the NIH.  See below.  I hope this is helpful to you

      Kevin

      Should women who previously were diagnosed with
      melanoma avoid pregnancy?

      The issue here is whether pregnancy activates micrometastatic
      disease. There is no convincing evidence
      that pregnancy activates or stimulates dormant micrometastatic
      disease, although anecdotal case reports
      certainly suggest that this may happen in some cases. One
      of the difficulties in addressing this question is that it is
      impossible to know prospectively which patients are harboring
      micrometastases. One author noted similar fiveand
      ten-year survival rates for 115 patients who were
      pregnant with melanoma compared with 330 female
      melanoma patients who were never pregnant during or after
      their diagnosis.’ The pregnant group, however, had a
      higher frequency of lymph node involvement at the time
      of diagnosis. A better survival was actually noted for 71
      patients who were pregnant within a year before or five
      years after a diagnosis of melanoma, but the control group
      consisted of only 31 women who did not get pregnant
      during a similar interval and who actually had higher
      stage disease.47 In another study, women diagnosed with
      melanoma before getting pregnant were compared with
      women diagnosed after completing all pregnancies.39 The
      latter group actually appeared to do worse at five years,
      although statistical comparison was not provided. In a retrospective
      study conducted at Duke University, 43
      women with stage I melanoma who became pregnant
      within the next five years had prognoses similar to those
      of 337 women who did not get pregnant, both in terms of
      relapse and disease-free survival.9
      There is no evidence that nulliparous women as a
      group differ from parous women as a group, in terms of
      prognosis from the time of a subsequent diagnosis of
      melanoma while pregnant. In a study that compared 85
      women diagnosed with melanoma before their first pregnancy
      with 143 women who had completed all pregnancies,
      melanoma developed in 68 between pregnancies and
      in 92 during pregnancy, and there was no difference in
      these groups.39 Two other small studies also found no difference
      in prognosis for nulliparous as opposed to parous
      women,4M42 although the studies were small in scope. The
      only trials that address the issue of the importance of subsequent
      pregnancy on prognosis have failed to identify
      parity as an important variable in multivariate analysis.39
      In the absence of definitive data, many authorities have
      recommended that women avoid pregnancy for two to
      five years after a diagnosis of melanoma, mainly because
      that is the time period during which most recurrences are
      diagnosed.’944149 In one study, such patients who did become
      pregnant were actually used as controls to compare
      with patients who were being diagnosed with melanoma
      for the first time while pregnant.37

      Should women who previously were diagnosed with
      melanoma during a pregnancy avoid subsequent pregnancy?
      Historically, there has been great concern regarding
      the risk of subsequent pregnancy in women who were initially
      diagnosed with melanoma during a previous pregnancy,
      based on the presumption that these melanomas in
      particular may be influenced adversely by growth factors
      and hormones secreted during pregnancy. Earlier observers
      felt strongly that pregnancy worsened the prognosis
      in this group of patients.2549 There is no objective
      evidence that this group is at higher risk with subsequent
      pregnancy, however. Despite this, the consensus is to recommend
      the deferral of subsequent pregnancy for two to
      three years in women in whom a primary melanoma developed
      during pregnancy.7

      Is there a risk of transplacental metastases to the fetus:?

      There definitely is a risk of transplacental transmission
      of melanoma from mother to fetus, but fortunately
      this risk is low.  Placental involvement itself is indicative
      of widespread hematogenous dissemination in the
      mother, but placental involvement does not necessarily
      mean that the newborn baby will have melanoma. Of 35
      cases of placental or fetal involvement with cancer following
      pregnancy, one study found that 11 were due to
      melanoma, the most common cancer associated with this
      phenomenon, followed by leukemia or lymphoma. Of
      the 11 melanoma patients, the placenta was involved in 7
      and the fetus in 6. Two of the infants with melanoma underwent
      spontaneous regression of disease after delivery.
      It has been suggested that only 25% of infants with placental
      metastatic melanoma will actually die of metastatic
      melanoma, and it is almost always manifest at the time
      of delivery and then fails to regress spontaneously after
      delivery. The implications of these observations are that
      women diagnosed with metastatic melanoma during
      pregnancy need not abort their fetus out of a fear of
      transplacental spread, and active therapy for a fetus born
      in the setting of placental metastases is not warranted.

       

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