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Is pregnancy safe for a melanoma patient post treatment?

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

  • Post
    sarah.e.lindsey
    Participant

      I am 4 years post treatment and surgery for stage 3 melanoma. I’ve completed 4 weeks of Interferon, a lymph node dissection and a wide excision with a snb. I have had negative scans since 2006. My husband and I are considering adding to our family, but are unsure of the risks involved with reoccurance. If anyone has any ad vice, I would greatly appreciate it!! Thanks.

      I am 4 years post treatment and surgery for stage 3 melanoma. I’ve completed 4 weeks of Interferon, a lymph node dissection and a wide excision with a snb. I have had negative scans since 2006. My husband and I are considering adding to our family, but are unsure of the risks involved with reoccurance. If anyone has any ad vice, I would greatly appreciate it!! Thanks.

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        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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            sarah.e.lindsey
            Participant

              Thank you Kevin for this information. This is exactly what I was asking for from my oncologist who was hesitant to tell me one way or another about the decision. We have a healthy and beautiful 5 year old daughter, and I am satisfied to leave it at her! Thank you so much, you have really helped us in our decision. Have a great day!

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