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Pregnancy after Melanoma?

Forums General Melanoma Community Pregnancy after Melanoma?

  • Post
    dennest
    Participant

      Hello,

      I was diagnosed back in April with a stage 1 melanoma. My site was .35mm. I had a wide excision and no further treatment. I know that I was incredibly lucky to have caught it so early, but now that some time has gone by, I feel like I should have done more even though further treatment is not recommended.

      Hello,

      I was diagnosed back in April with a stage 1 melanoma. My site was .35mm. I had a wide excision and no further treatment. I know that I was incredibly lucky to have caught it so early, but now that some time has gone by, I feel like I should have done more even though further treatment is not recommended.

      My husband and I are looking to have another child, and I am finding it extremely hard to decide if we should proceed with our family plan. Of course most doctors say we should wait for at least two years before getting pregnant. Has anyone had a similar experience with this? If so, how long did you wait, did your pregnancy go well, and did you have any recurrances, etc?

      Thank you.

       DEnnest

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    • Replies
        Ranisa
        Participant

          I am in the same boat….only a little farther down the river…I guess is how I would put it.  I had stage 1b in late July.  Surgery for WLE and SNB….one lymph node came back with "something".  Forwarded slides onto Mayo… pathologist sayed regular mole cells.  Wanted a baby.  I was in my OB office in July asking what I needed to do to prepare to get pregnant.  12 day later I found that mole really was cancer.  In October I moved and was given the okay to get pregnant after seeing my new derm and then got the verbal okay from the new onocolgist.  Then I went to see the onocologist and he said that my orginal dx was more aggressive than I was lead to belive or even what he thought it was when he gave me the verbal okay to get pregnant.  The mitotic index was a 3, and there was a focal extension of melanoma cells near a vascular structure.  With that he would not have given me the okay.  Well…..that was a little late.  I had my IUD out and got pregnant all within 2 weeks of the verbal okay.  He asked if I would give him permission to request and have my lymph node slides forwarded onto want he called the best lab to have a 3rd opinion on it.  I just got the call last Friday, GREAT NEWS!  The orginal dx of regular mole cells was correct.  Which keeps me at a stage 1b and not a stage 3a.  I am seeing my dermatolgist and oncologist every 6 weeks.  I havne't seen either one since getting the results back from the 3rd opinion on those 4 cells.  I will be followed closely and my OB seems fine with everything.  I will giving permission to all 3 of the doctors to communicate with each other freely and often.  I don't want to be the middle man and get something lost in translation. 

          From my understand early stages don't need to wait.  Later stages need to be NED for 2-3 years.  My advice, having been down this road…and still doing it right now.  MAKE SURE THAT YOU SEE A MELANOMA SPECIALIST!  NOT JUST SOMEONE WHO DEALS WITH IT BUT A SPECIALIST. Get the docs opinion and go from there. It does make a difference A BIG DIFFERENCE.  I have seen both kind of doctors…..I can tell you I feel the difference when I am in the office and when they are talking to me about things.  Let me know if you want to talk over the phone or something sometime.  I'd enjoy it.  Forgive my spelling….it really is the least of my worries right now.

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            dennest
            Participant

              Thank you so much for getting back to me and telling me your story. Congratulations on your pregnancy and I'm so glad to here that everything is going well so far!  Your experience is definetly reassuring to me and I am taking your advice to seek out a melanoma specialist. I will definetly keep you posted, and please update me on how you're doing as well.

              Thanks again!

              –Dennest

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              dennest
              Participant

                Thank you so much for getting back to me and telling me your story. Congratulations on your pregnancy and I'm so glad to here that everything is going well so far!  Your experience is definetly reassuring to me and I am taking your advice to seek out a melanoma specialist. I will definetly keep you posted, and please update me on how you're doing as well.

                Thanks again!

                –Dennest

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              Ranisa
              Participant

                I am in the same boat….only a little farther down the river…I guess is how I would put it.  I had stage 1b in late July.  Surgery for WLE and SNB….one lymph node came back with "something".  Forwarded slides onto Mayo… pathologist sayed regular mole cells.  Wanted a baby.  I was in my OB office in July asking what I needed to do to prepare to get pregnant.  12 day later I found that mole really was cancer.  In October I moved and was given the okay to get pregnant after seeing my new derm and then got the verbal okay from the new onocolgist.  Then I went to see the onocologist and he said that my orginal dx was more aggressive than I was lead to belive or even what he thought it was when he gave me the verbal okay to get pregnant.  The mitotic index was a 3, and there was a focal extension of melanoma cells near a vascular structure.  With that he would not have given me the okay.  Well…..that was a little late.  I had my IUD out and got pregnant all within 2 weeks of the verbal okay.  He asked if I would give him permission to request and have my lymph node slides forwarded onto want he called the best lab to have a 3rd opinion on it.  I just got the call last Friday, GREAT NEWS!  The orginal dx of regular mole cells was correct.  Which keeps me at a stage 1b and not a stage 3a.  I am seeing my dermatolgist and oncologist every 6 weeks.  I havne't seen either one since getting the results back from the 3rd opinion on those 4 cells.  I will be followed closely and my OB seems fine with everything.  I will giving permission to all 3 of the doctors to communicate with each other freely and often.  I don't want to be the middle man and get something lost in translation. 

                From my understand early stages don't need to wait.  Later stages need to be NED for 2-3 years.  My advice, having been down this road…and still doing it right now.  MAKE SURE THAT YOU SEE A MELANOMA SPECIALIST!  NOT JUST SOMEONE WHO DEALS WITH IT BUT A SPECIALIST. Get the docs opinion and go from there. It does make a difference A BIG DIFFERENCE.  I have seen both kind of doctors…..I can tell you I feel the difference when I am in the office and when they are talking to me about things.  Let me know if you want to talk over the phone or something sometime.  I'd enjoy it.  Forgive my spelling….it really is the least of my worries right now.

                Loading spinner
                Ranisa
                Participant

                  I am in the same boat….only a little farther down the river…I guess is how I would put it.  I had stage 1b in late July.  Surgery for WLE and SNB….one lymph node came back with "something".  Forwarded slides onto Mayo… pathologist sayed regular mole cells.  Wanted a baby.  I was in my OB office in July asking what I needed to do to prepare to get pregnant.  12 day later I found that mole really was cancer.  In October I moved and was given the okay to get pregnant after seeing my new derm and then got the verbal okay from the new onocolgist.  Then I went to see the onocologist and he said that my orginal dx was more aggressive than I was lead to belive or even what he thought it was when he gave me the verbal okay to get pregnant.  The mitotic index was a 3, and there was a focal extension of melanoma cells near a vascular structure.  With that he would not have given me the okay.  Well…..that was a little late.  I had my IUD out and got pregnant all within 2 weeks of the verbal okay.  He asked if I would give him permission to request and have my lymph node slides forwarded onto want he called the best lab to have a 3rd opinion on it.  I just got the call last Friday, GREAT NEWS!  The orginal dx of regular mole cells was correct.  Which keeps me at a stage 1b and not a stage 3a.  I am seeing my dermatolgist and oncologist every 6 weeks.  I havne't seen either one since getting the results back from the 3rd opinion on those 4 cells.  I will be followed closely and my OB seems fine with everything.  I will giving permission to all 3 of the doctors to communicate with each other freely and often.  I don't want to be the middle man and get something lost in translation. 

                  From my understand early stages don't need to wait.  Later stages need to be NED for 2-3 years.  My advice, having been down this road…and still doing it right now.  MAKE SURE THAT YOU SEE A MELANOMA SPECIALIST!  NOT JUST SOMEONE WHO DEALS WITH IT BUT A SPECIALIST. Get the docs opinion and go from there. It does make a difference A BIG DIFFERENCE.  I have seen both kind of doctors…..I can tell you I feel the difference when I am in the office and when they are talking to me about things.  Let me know if you want to talk over the phone or something sometime.  I'd enjoy it.  Forgive my spelling….it really is the least of my worries right now.

                  Loading spinner
                  Ranisa
                  Participant

                    I am in the same boat….only a little farther down the river…I guess is how I would put it.  I had stage 1b in late July.  Surgery for WLE and SNB….one lymph node came back with "something".  Forwarded slides onto Mayo… pathologist sayed regular mole cells.  Wanted a baby.  I was in my OB office in July asking what I needed to do to prepare to get pregnant.  12 day later I found that mole really was cancer.  In October I moved and was given the okay to get pregnant after seeing my new derm and then got the verbal okay from the new onocolgist.  Then I went to see the onocologist and he said that my orginal dx was more aggressive than I was lead to belive or even what he thought it was when he gave me the verbal okay to get pregnant.  The mitotic index was a 3, and there was a focal extension of melanoma cells near a vascular structure.  With that he would not have given me the okay.  Well…..that was a little late.  I had my IUD out and got pregnant all within 2 weeks of the verbal okay.  He asked if I would give him permission to request and have my lymph node slides forwarded onto want he called the best lab to have a 3rd opinion on it.  I just got the call last Friday, GREAT NEWS!  The orginal dx of regular mole cells was correct.  Which keeps me at a stage 1b and not a stage 3a.  I am seeing my dermatolgist and oncologist every 6 weeks.  I havne't seen either one since getting the results back from the 3rd opinion on those 4 cells.  I will be followed closely and my OB seems fine with everything.  I will giving permission to all 3 of the doctors to communicate with each other freely and often.  I don't want to be the middle man and get something lost in translation. 

                    From my understand early stages don't need to wait.  Later stages need to be NED for 2-3 years.  My advice, having been down this road…and still doing it right now.  MAKE SURE THAT YOU SEE A MELANOMA SPECIALIST!  NOT JUST SOMEONE WHO DEALS WITH IT BUT A SPECIALIST. Get the docs opinion and go from there. It does make a difference A BIG DIFFERENCE.  I have seen both kind of doctors…..I can tell you I feel the difference when I am in the office and when they are talking to me about things.  Let me know if you want to talk over the phone or something sometime.  I'd enjoy it.  Forgive my spelling….it really is the least of my worries right now.

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                    dian in spokane
                    Participant

                      Someone  recently posted a link to a 2009 study on pregnancy and melanoma. It's a subject that comes up here often, so I saved it. I hope you find it enlightening.

                      dian

                      http://www.sciencedaily.com/releases/2009/05/090504210204.htm

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                        Ranisa
                        Participant

                          I had a 1.1 mm.  So yes it was over 1, but really only by .1…..makes it not sound so bad, at least to me.  I am curious as to what else you find out.  Keep me posted.  So far so good for me, I am 11 weeks along.

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                          Ranisa
                          Participant

                            I had a 1.1 mm.  So yes it was over 1, but really only by .1…..makes it not sound so bad, at least to me.  I am curious as to what else you find out.  Keep me posted.  So far so good for me, I am 11 weeks along.

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                            Ranisa
                            Participant

                              I had a 1.1 mm.  So yes it was over 1, but really only by .1…..makes it not sound so bad, at least to me.  I am curious as to what else you find out.  Keep me posted.  So far so good for me, I am 11 weeks along.

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                              Ranisa
                              Participant

                                I had a 1.1 mm.  So yes it was over 1, but really only by .1…..makes it not sound so bad, at least to me.  I am curious as to what else you find out.  Keep me posted.  So far so good for me, I am 11 weeks along.

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                                dennest
                                Participant

                                  Thank you for the article…it was very helpful!! I appreciate all the feedback. Take care!!

                                  —Dennest

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                                  dennest
                                  Participant

                                    Thank you for the article…it was very helpful!! I appreciate all the feedback. Take care!!

                                    —Dennest

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                                  dian in spokane
                                  Participant

                                    Someone  recently posted a link to a 2009 study on pregnancy and melanoma. It's a subject that comes up here often, so I saved it. I hope you find it enlightening.

                                    dian

                                    http://www.sciencedaily.com/releases/2009/05/090504210204.htm

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                                    ErikaHouston2
                                    Participant

                                      I don't think you'd find a Dr. that would even offer you further treatment for a stage I. You did EXACTLY what you were supposed to do.

                                      I was diagnosed with Stage IA in Oct '08  (.65mm).  At the time of diagnosis I had a 6 month old.  My Dr's did not tell me to wait to get pregnant.

                                      I got pregnant in August of '09 and now have a beautiful 10 month old. Wouldn't change it for the world. I did go to the derm every 3 months during the pregnancy.

                                       You're very fortunate to have caught the melanoma so early. Get busy having another baby :-).

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                                        Ranisa
                                        Participant

                                          I think the worry is that there was a vascular structure near the melanoma and the Mitotic index was higher than he would have liked to see.  My follow up care is to see Oncologist and Dermatologist rotating every 6 weeks. 

                                          I am going to try to post this one without having it end up as a double post!  ;o).  Thanks to everyone who has posted, I am loving that I will end with a baby at the end of this, but the morning sickness if ruff.

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                                          Ranisa
                                          Participant

                                            I think the worry is that there was a vascular structure near the melanoma and the Mitotic index was higher than he would have liked to see.  My follow up care is to see Oncologist and Dermatologist rotating every 6 weeks. 

                                            I am going to try to post this one without having it end up as a double post!  ;o).  Thanks to everyone who has posted, I am loving that I will end with a baby at the end of this, but the morning sickness if ruff.

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                                            Ranisa
                                            Participant

                                              I agree with Erica!  Sorry forgot to add this.  I am so flakey when pregnant. 

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                                              Ranisa
                                              Participant

                                                I agree with Erica!  Sorry forgot to add this.  I am so flakey when pregnant. 

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                                              ErikaHouston2
                                              Participant

                                                I don't think you'd find a Dr. that would even offer you further treatment for a stage I. You did EXACTLY what you were supposed to do.

                                                I was diagnosed with Stage IA in Oct '08  (.65mm).  At the time of diagnosis I had a 6 month old.  My Dr's did not tell me to wait to get pregnant.

                                                I got pregnant in August of '09 and now have a beautiful 10 month old. Wouldn't change it for the world. I did go to the derm every 3 months during the pregnancy.

                                                 You're very fortunate to have caught the melanoma so early. Get busy having another baby :-).

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                                                kab07011
                                                Participant

                                                  Hi,

                                                  I will give you a bite.

                                                  My melanoma was dx in 9/09, WLE and SNB in 10/09 with clear nodes. Original site was lower back .97 breslow and ulcerated. I became pregnant 2 months after surgery in 01/10 and had no problems and delivered a healthy baby boy on 09/28/10. Still being seen every 4 months for total body checks.

                                                  I would be happy to answer any other questions you may have. Definately live your life to the fullest at this stage you are not recommended to prevent or do anything different.

                                                  Kim

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                                                  kab07011
                                                  Participant

                                                    Hi,

                                                    I will give you a bite.

                                                    My melanoma was dx in 9/09, WLE and SNB in 10/09 with clear nodes. Original site was lower back .97 breslow and ulcerated. I became pregnant 2 months after surgery in 01/10 and had no problems and delivered a healthy baby boy on 09/28/10. Still being seen every 4 months for total body checks.

                                                    I would be happy to answer any other questions you may have. Definately live your life to the fullest at this stage you are not recommended to prevent or do anything different.

                                                    Kim

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                                                    kab07011
                                                    Participant

                                                      Hi,

                                                      I will give you a bite.

                                                      My melanoma was dx in 9/09, WLE and SNB in 10/09 with clear nodes. Original site was lower back .97 breslow and ulcerated. I became pregnant 2 months after surgery in 01/10 and had no problems and delivered a healthy baby boy on 09/28/10. Still being seen every 4 months for total body checks.

                                                      I would be happy to answer any other questions you may have. Definately live your life to the fullest at this stage you are not recommended to prevent or do anything different.

                                                      Kim

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                                                        dennest
                                                        Participant

                                                          Thank you, thank you, thank you!!  Hearing your situation and progress is really giving me the boost I need to move on and keep my life going as planned! Good luck!! Thanks again.

                                                          –Dennest

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                                                          dennest
                                                          Participant

                                                            Thank you, thank you, thank you!!  Hearing your situation and progress is really giving me the boost I need to move on and keep my life going as planned! Good luck!! Thanks again.

                                                            –Dennest

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                                                          kab07011
                                                          Participant

                                                            Hi,

                                                            I will give you a bite.

                                                            My melanoma was dx in 9/09, WLE and SNB in 10/09 with clear nodes. Original site was lower back .97 breslow and ulcerated. I became pregnant 2 months after surgery in 01/10 and had no problems and delivered a healthy baby boy on 09/28/10. Still being seen every 4 months for total body checks.

                                                            I would be happy to answer any other questions you may have. Definately live your life to the fullest at this stage you are not recommended to prevent or do anything different.

                                                            Kim

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                                                            [email protected]
                                                            Participant

                                                              Hi, Dennest,

                                                              I was diagnosed back in 1989. The melanoma was on my back. I had a wide excision to remove it with no other treatment. This happened six months before my wedding. My surgeon advised us to wait two years before becoming pregnant. We did exactly that. I went on to have three children. I am still seen regularly by a dermatologist.

                                                               

                                                              The best to you,

                                                              Marian

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                                                              [email protected]
                                                              Participant

                                                                Hi, Dennest,

                                                                I was diagnosed back in 1989. The melanoma was on my back. I had a wide excision to remove it with no other treatment. This happened six months before my wedding. My surgeon advised us to wait two years before becoming pregnant. We did exactly that. I went on to have three children. I am still seen regularly by a dermatologist.

                                                                 

                                                                The best to you,

                                                                Marian

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                                                                FertilityDoc
                                                                Participant

                                                                  DEnnest,

                                                                  I have placed some information from the NIH below.  It is always a hard decision with imperfect data to guide us.  At stage 1 you might be okay but I would still discuss it with a melanoma specialist.  You have to take your own reproductive age into consideration.  If you are in your late 20's or early 30's you have time.  If you are in your mid thirties and beyond, you need to take overall fertility into consideration.

                                                                  Hope it helps,

                                                                  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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                                                                  FertilityDoc
                                                                  Participant

                                                                    DEnnest,

                                                                    I have placed some information from the NIH below.  It is always a hard decision with imperfect data to guide us.  At stage 1 you might be okay but I would still discuss it with a melanoma specialist.  You have to take your own reproductive age into consideration.  If you are in your late 20's or early 30's you have time.  If you are in your mid thirties and beyond, you need to take overall fertility into consideration.

                                                                    Hope it helps,

                                                                    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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