Gulino F A, Ettore C, Pappalardo E, Blanco M C, Ettore G, Capriglione S
Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e Alta Specializzazione (ARNAS) Garibaldi, Catania, Italy.
Department of Obstetrics and Gynecology, Istituto per la Sicurezza Sociale, Cailungo - Borgo Maggiore, Repubblica di San Marino.
J Matern Fetal Neonatal Med. 2022 Jun;35(11):2195-2202. doi: 10.1080/14767058.2020.1777538. Epub 2020 Jun 19.
Pregnancy- associated melanoma (PAM) is reported between 2.8 and 5.0 per 100,000 pregnancies and approximately 35% of women with melanoma are of childbearing age. The diagnosis and treatment of melanoma during pregnancy needs a balance of risks and benefits for both maternal and fetal well-being. It is a type of malignancy, which requires a multidisciplinary approach, not limited to the obstetrician, but also to oncologists, neonatologists, pharmacists and psychologists.
We present a case of a 36-year-old pregnant woman, who was admitted to our 3 level Unit of Obstetrics and Gynecology (ARNAS Garibaldi Nesima) at 27 weeks and 2 days of gestation, with a diagnosis of suspected infection, then diagnosed as an advanced melanoma, which caused a premature delivery. A review of the literature of the last ten years from the international electronic bibliographic databases PUBMED was performed following the PRISMA Statement (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). The search was limited to studies reported in the English language. We only included articles that followed our eligibility criteria, represented by: pregnant women with a diagnosis of advanced melanoma in pregnancy, with special reference to maternal, fetal or perinatal outcomes.
The patient was affected by an 11 cm pregnancy-associated melanoma in the lower part back, with 2 hepatic metastasis. Due to the quickly development of general symptoms of sepsis it was decided to perform an urgent C-section. For the systematic review, we found 11 articles of advanced clinical melanoma, providing data from 12 patients. Maternal-perinatal outcomes is different depending on gestational age, general clinical condition, stage at diagnosis.
Advanced melanoma is usually associated with a higher rate of termination of pregnancy, If the pregnancy continues, for the mother is associated with an higher risk of Cesarean section, sepsis, maternal progression of disease; for the baby is associated with prematurity, low birth weight, neonatal metastatic disease, neonatal morbidity and mortality. The future aim of clinicians should be the creation of an international database of the clinical cases of pregnancy-associated melanoma, to evaluate the same data, to improve treatments, to develop common protocols, and, finally, to improve the obstetric and perinatal outcomes.
妊娠相关黑色素瘤（PAM）的报告发病率为每10万次妊娠中有2.8至5.0例，且约35%的黑色素瘤女性处于育龄期。孕期黑色素瘤的诊断和治疗需要在母婴健康的风险与益处之间取得平衡。它是一种恶性肿瘤，需要多学科方法，不仅限于产科医生，还包括肿瘤学家、新生儿科医生、药剂师和心理学家。
我们呈现了一例36岁孕妇的病例，她在妊娠27周零2天时入住我们三级妇产科单元（ARNAS加里波第·内西马），最初诊断为疑似感染，随后被诊断为晚期黑色素瘤，这导致了早产。按照PRISMA声明（系统评价和Meta分析的首选报告项目）对国际电子文献数据库PUBMED中过去十年的文献进行了回顾。搜索仅限于英文报道的研究。我们仅纳入符合我们纳入标准的文章，标准为：诊断为孕期晚期黑色素瘤的孕妇，特别提及母婴或围产期结局。
该患者背部下方有一个11厘米的妊娠相关黑色素瘤，并伴有2处肝转移。由于败血症全身症状迅速发展，决定进行紧急剖宫产。对于系统评价，我们找到了11篇晚期临床黑色素瘤的文章，提供了12例患者的数据。母婴围产期结局因孕周、一般临床状况、诊断时的分期而异。
晚期黑色素瘤通常与较高的妊娠终止率相关，如果妊娠继续，对母亲而言与剖宫产、败血症、疾病进展的风险增加相关；对婴儿而言与早产、低出生体重、新生儿转移性疾病、新生儿发病率和死亡率相关。临床医生未来的目标应该是创建一个妊娠相关黑色素瘤临床病例的国际数据库，以评估相同的数据，改进治疗方法，制定通用方案，并最终改善产科和围产期结局。
