Diagnostic and therapeutic procedures for management of melanoma during pregnancy: risks for the fetus?

In the treatment of malignant melanoma, various stage-dependent diagnostic and therapeutic procedures are widely accepted. The situation becomes more complicated in pregnant women due to potential hazardous side effects to the fetus. We report on a 36-year-old woman, who was admitted with a high-risk malignant melanoma on the right cheek. Prior to surgery we performed computed tomography (CT)-scans that were unremarkable with the exception of "two small cysts of the uterus" The primary melanoma was excised and a sentinel node biopsy was performed under general anesthesia using radioactive tracers. Afterwards, adjuvant therapy with interferon alpha 2b was initiated. Five weeks later our patient reported that she was pregnant with twins in their eleventh week of gestation, although she previously denied several questions regarding a potential pregnancy. She declined the offer of an abortion and elected to continue with the interferon treatment against our medical advice. In the 36(th) week of gestation, she developed regional lymph node metastases. Consequently, labor was induced, resulting in the delivery of healthy twins. Six months later our patient developed lung metastases. Despite several chemotherapy regimens, she died one year later. An interdisciplinary approach to obtaining informed consent and managing female high risk melanoma patients with potential or present pregnancy is presented.