Zusammenfassung
Pro Jahr sieht jedes große Zentrum etwa 1 Fall mit einer schwangeren Patientin mit Erstdiagnose eines Melanoms. Diese seltene klinische Herausforderung gilt es zu meistern. Auf der Basis der Literatur ist evident, dass die primär chirurgische Therapie des Melanoms in der Schwangerschaft mit entsprechenden Anpassungen in gleichem Umfang erfolgen kann und soll, wie bei Nichtschwangeren. Anpassungen betreffen die Terminierung, Narkoseführung, Medikamente und die bildgebenden Untersuchungen. Für die adjuvante Interferontherapie und die Systemtherapie im seltenen Fall einer metastasierten Situation bestehen bei bisher nur 30 solchen Fällen in der Weltliteratur nur wenig klinische Erfahrungen, sodass auf der Basis der präklinischen Daten nur Hinweise für eine individuelle Entscheidungsfindung gegeben werden können.
Abstract
Melanoma diagnosed during pregnancy is a rare clinical case presentation which must be mastered. In the absence of guidelines for this clinical challenge, we performed a review of the literature and provide a practical guideline on how to manage such rare clinical cases based on our clinical experience. Expecting mothers require adequate counselling and explanation of all therapeutic options as they take responsibility for more than their own lives. However, they should be guided through the process of diagnostic and therapeutic measures in a potentially life-threatening situation. Pregnancy itself is no reason to withhold any type of necessary melanoma surgery. Perioperative management, however, requires certain adjustments in order to comply with this special situation. If indicated, even adjuvant and palliative systemic therapy need to be given to the patient, but they also have to be adapted to the specific circumstances as data is still sparse, especially for the new first and second line therapies with antibodies and targeted molecules.
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Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Falle von nicht mündigen Patienten liegt die Einwilligung eines Erziehungsberechtigten oder des gesetzlich bestellten Betreuers vor.
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Schneider, L.A. Versorgung des Melanoms in der Schwangerschaft. Hautarzt 68, 103–110 (2017). https://doi.org/10.1007/s00105-016-3915-y
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DOI: https://doi.org/10.1007/s00105-016-3915-y