Sentinel Lymph Node Biopsy for Melanoma in Pregnant Women
The incidence of melanoma is rising in young women of childbearing age. Melanoma diagnosed during pregnancy presents unique challenges. This study was conducted to determine the effect of sentinel lymph node biopsy (SLNB) for melanoma on maternal and fetal outcomes in pregnant women.
A prospective melanoma database was retrospectively queried for women diagnosed with melanoma during or immediately before pregnancy as well as SLNB in pregnant women. The outcomes of SLNB for the mothers and fetuses were evaluated.
Fifteen pregnant women underwent wide local excision (WLE) and SLNB for melanoma from 1997 to 2012. The median gestational age was 20 weeks. More than half of the women noticed changes in the primary melanoma lesion during the pregnancy. The median Breslow thickness was 1.00 mm. Lymphatic mapping and SLNB were performed with some combination of radiocolloid or vital blue dye without adverse effects. Three patients had micrometastatic disease and underwent a completion lymphadenectomy. Sixteen children were born at a median gestational age of 39 weeks. The median 1- and 5-minute Apgar scores were 8 and 9, respectively. At a median follow-up of 54.4, months none of the patients had experienced recurrence, and all children were healthy and free of melanoma.
In this series of pregnant women with melanoma, SLNB was performed safely during pregnancy without adverse effects to the mothers and fetuses. We recommend that clinicians explain the risks and benefits of the SLNB procedure to pregnant women so an informed decision can be made about the procedure.
- 1.American Cancer Society. Melanoma Skin Cancer Overview. Revised January 23, 2012. http://www.cancer.org/acs/groups/cid/documents/webcontent/003063-pdf.pdf (January 23, 2012).
- 7.National Comprehensive Cancer Network. NCCN guidelines, melanoma. Version 3. 2012.Google Scholar
- 13.Lewis KD, Gonzalez R, Robinson WA, Fitzpatrick JE, McCarter MD, Braden C. A young woman with melanoma diagnosed during pregnancy. Oncology (Williston Park). 2004;18:794–9.Google Scholar
- 15.U.S. Census Bureau. American community survey 2008 (table S1301) and special tabulations. http://www.census.gov/hhes/fertility/data/cps/2008.html (January 30, 2012).
- 27.Raut CP, Hunt KK, Akins JS, et al. Incidence of anaphylactoid reactions to isosulfan blue dye during breast carcinoma lymphatic mapping in patients treated with preoperative prophylaxis: results of a surgical prospective clinical practice protocol. Cancer. 2005;104:692–9.PubMedCrossRefGoogle Scholar
- 37.Andtbacka RHI, Grissom CB, Boucher K, et al. Fluorescein identifies sentinel lymph nodes safely and precisely in patients with stage I and II cutaneous melanoma. The 7th International Sentinel Node Society meeting, Yokohama, Japan, November 19, 2010.Google Scholar