Malignant melanoma and pregnancy

Malignant melanoma is a serious health problem worldwide and is increasing at a rate that exceeds all other solid tumors [1]. The increasing incidence is accompanied by an associated decrease in age at presentation. It is the most common cancer in women ages 25–29 years and approximately 35% of women with melanoma are of child-bearing age [2]. Malignant melanoma during pregnancy has an estimated incidence between 0.14 and 2.8 cases per 1,000 births [3] and represents 8% of malignancies diagnosed during pregnancy [4]. The signs and symptoms of melanoma are similar to the nonpregnant population and the anatomic location of the primary tumor does not differ between pregnant and nonpregnant women [5]. Changes in size, color, and configuration of any pigmented lesion suggest a malignant change and the need for further investigation [6]. Two-thirds of melanomas occur in pre-existing nevi [7]. However, some degree of hyperpigmentation during pregnancy is experienced by most women [8]. It has been suggested that this hyperpigmentation may lead to a delay in diagnosis of the disease [9]. A growing number of reports suggest minimal changes in size occur during pregnancy [10–12]. Bleeding and ulceration are more ominous signs and require immediate attention. Excisional biopsy is the recommended procedure for any suspicious lesions. Staging Clinical staging traditionally has included assessment of the local tumor site and adjacent skin, regional lymph node areas, and distant organs that are frequently the site of metastatic disease. The decision to perform radiological investigations in the pregnant patient should be based on the presence of symptoms, the stage of the pregnancy, the specific test needed, and the estimated dose of ionizing radiation and risks associated with that dose. In most cases, the doses involved in diagnostic radiology, including computed tomography scan of abdomen and pelvis, are lower than the threshold dose that may place the fetus at risk [13].