Melanoma and Pregnancy: Risks, Current, and Forecast

*Ignatko Irina Vladimirovna and Strizhakov Alexander Nikolaevich*

### **Abstract**

Currently, the term "melanoma associated with pregnancy" is used, implying the inclusion of all clinical observations of melanoma diagnosis during pregnancy and in the first 2 years after delivery. The management of pregnant women with newly diagnosed melanoma is likewise controversial, especially with regard to the management of women with an advanced melanoma. Thrombotic complications are the most common form of paraneoplastic syndrome, which largely determines the prognosis of the disease. The presented chapter is intended to familiarize practical physicians with the complexities that arise in the management of pregnant women with a developing metastatic disease, with questions of the progression of the disease during pregnancy, with the emergence of severe paraneoplastic complications involving secondary thrombophilia, amaranthine endocarditis, and widespread arterial thrombosis. The possibility of using modern antitumor drugs (Zelboraf) is shown. It is emphasized that in the management of such patients, the need for an effective team of specialists of various profiles is especially high: oncologists, obstetrician-gynecologists, surgeons, hematologists, anesthesiologistresuscitators, and US and magnetic resonance imaging (MRI) diagnostics.

**Keywords:** melanoma, pregnancy, secondary thrombophilia, paraneoplastic syndrome, vemurafenib

#### **1. Introduction**

Melanoma of the skin (*lat. —melanoma, melanoma malignum*) is a malignant tumor that results from neoplastic transformation of melanocytes—cells that produce various variations of melanin pigment [1]. In recent years, there has been an increase in the incidence of skin melanoma in Russia. Between 1998 and 2008, the incidence rate in the Russian Federation was 38.17%, and the standardized morbidity rate rose from 4.04 to 5.46 per 100,000 population. In 2008, the number of new cases of melanoma in the Russian Federation was 7744 people. Mortality from melanoma in the Russian Federation in 2008 was 3159 people and a standardized death rate of 2.23 people per 100,000 population [2]. Approximately one-third of women diagnosed with melanoma are of childbearing age, and a 2015 Swedish population-based cancer registry study found that melanoma was the most common malignancy in pregnancy [3]. Melanoma is a significant proportion of all tumors diagnosed during pregnancy, and this figure is up to 25% among all tumor diseases during gestation. There is continuing controversy concerning the

prognosis of women diagnosed with melanoma during pregnancy. Initial concerns about pregnancy's impact on prognosis in women diagnosed with melanoma date back to case reports from the 1950s. These reports suggested that pregnancy might lead to transformation of nevi into melanomas, increase the growth rate of existing melanomas, and cause localized melanomas to metastasize [4]. Subsequently, multiple observations seemed to support the argument that melanoma is a hormonally responsive malignancy: changes in skin pigmentation during pregnancy, detection of hormone receptors on some melanomas using older technology, a higher incidence of melanoma after puberty, and relative immunosuppression during pregnancy. The management of women diagnosed with melanoma during pregnancy is likewise controversial, particularly concerning sentinel lymph node biopsy (SLNB) and decisions about the management of the patient with nodal or metastatic disease [5]. Multiple studies have looked at the relationship between pregnancy and cutaneous melanoma. Factors limiting the interpretation of the literature include the following:

