Vurture Gregory, Klein Brittany, Shapiro Richard, Baum Jonathan
Obstetrics and Gynecology, Hackensack Meridian, Jersey Shore University Medical Center, Neptune, USA.
Surgical Oncology, New York University Langone Medical Center, New York, USA.
Cureus. 2024 Aug 6;16(8):e66279. doi: 10.7759/cureus.66279. eCollection 2024 Aug.
Melanoma is increasingly common among reproductive-age women and is one of the most common cancers diagnosed during pregnancy. The literature for melanoma in pregnancy, especially among those with prior uterine scars, is limited. We present an interesting case of a 22-year-old woman who went to her dermatologist for a suspicious lesion on her thigh. The lesion was excised, and histopathology confirmed that it was a melanoma. The dermatologist recommended immediate delivery. The patient then urged her obstetrician to undergo the risks of an induction of labor (IOL) for a trial of labor after cesarean (TOLAC) because she desired a large family, and a second cesarean would make this more difficult to happen. She ultimately had a successful vaginal birth after cesarean (VBAC) and subsequent excision of the melanoma with surgical oncology in the immediate postpartum period. Therefore, the decision for IOL for TOLAC in this case was based on the patient's fears regarding melanoma disease progression in her 39th week. Given the short time course between delivery and excision of her melanoma, it is possible that she may have been able to wait for spontaneous labor, which would have avoided the risks associated with IOL for TOLAC. The optimal timing of surgical intervention for melanoma in pregnant patients who desire TOLAC is unknown. In pregnancies that are approaching their due date, waiting for spontaneous labor may be a reasonable approach to avoid the risks of labor induction, especially in women with prior cesarean delivery. A multidisciplinary approach involving dermatology, surgical oncology, and the obstetric team is warranted to optimize both dermatologic and obstetric outcomes.
黑色素瘤在育龄女性中越来越常见，是孕期诊断出的最常见癌症之一。关于孕期黑色素瘤的文献，尤其是有子宫瘢痕史者的相关文献有限。我们报告一例有趣的病例，一名22岁女性因大腿上的可疑皮损前往皮肤科就诊。该皮损被切除，组织病理学证实为黑色素瘤。皮肤科医生建议立即分娩。患者随后敦促其产科医生承担引产风险以尝试剖宫产术后阴道试产（TOLAC），因为她想要一个大家庭，再次剖宫产会使这一愿望更难实现。她最终成功进行了剖宫产术后阴道分娩（VBAC），并在产后立即由外科肿瘤学团队切除了黑色素瘤。因此，本例中决定进行引产以尝试TOLAC是基于患者对其39周时黑色素瘤病情进展的担忧。鉴于其黑色素瘤切除与分娩之间的时间较短，她有可能等待自然分娩，这本来可以避免与TOLAC引产相关的风险。对于希望进行TOLAC的孕妇，黑色素瘤手术干预的最佳时机尚不清楚。在接近预产期的妊娠中，等待自然分娩可能是避免引产风险的合理方法，尤其是对于有剖宫产史的女性。需要皮肤科、外科肿瘤学和产科团队采取多学科方法，以优化皮肤科和产科结局。
