๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
MELANOMA AND PREGNANCY
Melanoma accounts for 25%โ30% of all cancers diagnosed during pregnancy, and the incidence has been increasing. Although 10% of women experience darkening of their melanocytic nevi during the first 3 months of pregnancy, proportionate enlargement of nevi occurs within skin that has expanded due to the pregnancy (e.g. abdomen, breasts). Both biopsy and wide local excision (WLE) with small amounts of lidocaine and epinephrine (adrenaline) are considered safe to perform during pregnancy and should not be delayed. If SLNB is indicated, US National Comprehensive Cancer Network (NCCN) and AAD (2019) guidelines suggest waiting until at least the second trimester to avoid potential fetal complications of general anesthesia. Both isosulfan blue and methylene blue are contraindicated in pregnancy due to risk of fetal harm, but use of radiotracer is supported by limited data, although fetal radiation dose is not known. Alternatively, in lieu of immediate SLNB, regional surveillance ultrasound can be safely utilized to monitor the draining nodal basin(s) until SLNB can be safely performed. For surveillance and imaging, non-ionizing radiation modalities such as MRI and ultrasound are preferred, as exposure to radiation from CT, X-ray, and PET scans may lead to an increased risk of fetal carcinogenesis.
An association between hormonal changes during pregnancy and development of melanoma or worsening of the prognosis of an existing melanoma has not been demonstrated in stage 0โIII disease. Moreover, there are no studies demonstrating that exogenous hormones (e.g. oral contraceptives, hormone-containing contraceptive devices/implants, postmenopausal hormone replacement therapy, hormones associated with assisted reproductive technology) increase the risk of developing cutaneous melanoma. There is also no evidence to suggest that subsequent pregnancies after a cutaneous melanoma diagnosis result in an increased risk of recurrence or development of additional primary melanomas. In fact, higher parity is associated with decreased risk of developing melanoma. That said, in women diagnosed with stage II/ III melanomas, consideration of a 2- to 3-year waiting period may be practical given that most recurrences occur during that time period. Lastly, with systemic treatments such as immune checkpoint inhibitors and targeted agents there may be increased risk of fetal toxicity.