Pregnancy after Melanoma?

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2/16/2011 8:28pm
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Replies: 15

Hello,

I was diagnosed back in April with a stage 1 melanoma. My site was .35mm. I had a wide excision and no further treatment. I know that I was incredibly lucky to have caught it so early, but now that some time has gone by, I feel like I should have done more even though further treatment is not recommended.

My husband and I are looking to have another child, and I am finding it extremely hard to decide if we should proceed with our family plan. Of course most doctors say we should wait for at least two years before getting pregnant. Has anyone had a similar experience with this? If so, how long did you wait, did your pregnancy go well, and did you have any recurrances, etc?

Thank you.

 DEnnest

Ranisa - (2/17/2011 - 6:20pm)

I am in the same boat....only a little farther down the river...I guess is how I would put it.  I had stage 1b in late July.  Surgery for WLE and SNB....one lymph node came back with "something".  Forwarded slides onto Mayo... pathologist sayed regular mole cells.  Wanted a baby.  I was in my OB office in July asking what I needed to do to prepare to get pregnant.  12 day later I found that mole really was cancer.  In October I moved and was given the okay to get pregnant after seeing my new derm and then got the verbal okay from the new onocolgist.  Then I went to see the onocologist and he said that my orginal dx was more aggressive than I was lead to belive or even what he thought it was when he gave me the verbal okay to get pregnant.  The mitotic index was a 3, and there was a focal extension of melanoma cells near a vascular structure.  With that he would not have given me the okay.  Well.....that was a little late.  I had my IUD out and got pregnant all within 2 weeks of the verbal okay.  He asked if I would give him permission to request and have my lymph node slides forwarded onto want he called the best lab to have a 3rd opinion on it.  I just got the call last Friday, GREAT NEWS!  The orginal dx of regular mole cells was correct.  Which keeps me at a stage 1b and not a stage 3a.  I am seeing my dermatolgist and oncologist every 6 weeks.  I havne't seen either one since getting the results back from the 3rd opinion on those 4 cells.  I will be followed closely and my OB seems fine with everything.  I will giving permission to all 3 of the doctors to communicate with each other freely and often.  I don't want to be the middle man and get something lost in translation. 

From my understand early stages don't need to wait.  Later stages need to be NED for 2-3 years.  My advice, having been down this road...and still doing it right now.  MAKE SURE THAT YOU SEE A MELANOMA SPECIALIST!  NOT JUST SOMEONE WHO DEALS WITH IT BUT A SPECIALIST. Get the docs opinion and go from there. It does make a difference A BIG DIFFERENCE.  I have seen both kind of doctors.....I can tell you I feel the difference when I am in the office and when they are talking to me about things.  Let me know if you want to talk over the phone or something sometime.  I'd enjoy it.  Forgive my spelling....it really is the least of my worries right now.

dennest - (2/22/2011 - 9:35am)

Thank you so much for getting back to me and telling me your story. Congratulations on your pregnancy and I'm so glad to here that everything is going well so far!  Your experience is definetly reassuring to me and I am taking your advice to seek out a melanoma specialist. I will definetly keep you posted, and please update me on how you're doing as well.

Thanks again!

--Dennest

Ranisa - (2/17/2011 - 6:20pm)

I am in the same boat....only a little farther down the river...I guess is how I would put it.  I had stage 1b in late July.  Surgery for WLE and SNB....one lymph node came back with "something".  Forwarded slides onto Mayo... pathologist sayed regular mole cells.  Wanted a baby.  I was in my OB office in July asking what I needed to do to prepare to get pregnant.  12 day later I found that mole really was cancer.  In October I moved and was given the okay to get pregnant after seeing my new derm and then got the verbal okay from the new onocolgist.  Then I went to see the onocologist and he said that my orginal dx was more aggressive than I was lead to belive or even what he thought it was when he gave me the verbal okay to get pregnant.  The mitotic index was a 3, and there was a focal extension of melanoma cells near a vascular structure.  With that he would not have given me the okay.  Well.....that was a little late.  I had my IUD out and got pregnant all within 2 weeks of the verbal okay.  He asked if I would give him permission to request and have my lymph node slides forwarded onto want he called the best lab to have a 3rd opinion on it.  I just got the call last Friday, GREAT NEWS!  The orginal dx of regular mole cells was correct.  Which keeps me at a stage 1b and not a stage 3a.  I am seeing my dermatolgist and oncologist every 6 weeks.  I havne't seen either one since getting the results back from the 3rd opinion on those 4 cells.  I will be followed closely and my OB seems fine with everything.  I will giving permission to all 3 of the doctors to communicate with each other freely and often.  I don't want to be the middle man and get something lost in translation. 

From my understand early stages don't need to wait.  Later stages need to be NED for 2-3 years.  My advice, having been down this road...and still doing it right now.  MAKE SURE THAT YOU SEE A MELANOMA SPECIALIST!  NOT JUST SOMEONE WHO DEALS WITH IT BUT A SPECIALIST. Get the docs opinion and go from there. It does make a difference A BIG DIFFERENCE.  I have seen both kind of doctors.....I can tell you I feel the difference when I am in the office and when they are talking to me about things.  Let me know if you want to talk over the phone or something sometime.  I'd enjoy it.  Forgive my spelling....it really is the least of my worries right now.

Someone  recently posted a link to a 2009 study on pregnancy and melanoma. It's a subject that comes up here often, so I saved it. I hope you find it enlightening.

dian

http://www.sciencedaily.com/releases/2009/05/090504210204.htm

Ranisa - (2/18/2011 - 7:58pm)

I had a 1.1 mm.  So yes it was over 1, but really only by .1.....makes it not sound so bad, at least to me.  I am curious as to what else you find out.  Keep me posted.  So far so good for me, I am 11 weeks along.

Ranisa - (2/18/2011 - 7:59pm)

I had a 1.1 mm.  So yes it was over 1, but really only by .1.....makes it not sound so bad, at least to me.  I am curious as to what else you find out.  Keep me posted.  So far so good for me, I am 11 weeks along.

dennest - (2/22/2011 - 9:36am)

Thank you for the article...it was very helpful!! I appreciate all the feedback. Take care!!

---Dennest

I don't think you'd find a Dr. that would even offer you further treatment for a stage I. You did EXACTLY what you were supposed to do.

I was diagnosed with Stage IA in Oct '08  (.65mm).  At the time of diagnosis I had a 6 month old.  My Dr's did not tell me to wait to get pregnant.

I got pregnant in August of '09 and now have a beautiful 10 month old. Wouldn't change it for the world. I did go to the derm every 3 months during the pregnancy.

 You're very fortunate to have caught the melanoma so early. Get busy having another baby :-).

Ranisa - (2/23/2011 - 9:10am)

I think the worry is that there was a vascular structure near the melanoma and the Mitotic index was higher than he would have liked to see.  My follow up care is to see Oncologist and Dermatologist rotating every 6 weeks. 

I am going to try to post this one without having it end up as a double post!  ;o).  Thanks to everyone who has posted, I am loving that I will end with a baby at the end of this, but the morning sickness if ruff.

Ranisa - (2/23/2011 - 9:12am)

I agree with Erica!  Sorry forgot to add this.  I am so flakey when pregnant. 

kab07011 - (2/23/2011 - 7:51pm)

Hi,

I will give you a bite.

My melanoma was dx in 9/09, WLE and SNB in 10/09 with clear nodes. Original site was lower back .97 breslow and ulcerated. I became pregnant 2 months after surgery in 01/10 and had no problems and delivered a healthy baby boy on 09/28/10. Still being seen every 4 months for total body checks.

I would be happy to answer any other questions you may have. Definately live your life to the fullest at this stage you are not recommended to prevent or do anything different.

Kim

kab07011 - (2/23/2011 - 7:51pm)

Hi,

I will give you a bite.

My melanoma was dx in 9/09, WLE and SNB in 10/09 with clear nodes. Original site was lower back .97 breslow and ulcerated. I became pregnant 2 months after surgery in 01/10 and had no problems and delivered a healthy baby boy on 09/28/10. Still being seen every 4 months for total body checks.

I would be happy to answer any other questions you may have. Definately live your life to the fullest at this stage you are not recommended to prevent or do anything different.

Kim

dennest - (3/5/2011 - 10:46am)

Thank you, thank you, thank you!!  Hearing your situation and progress is really giving me the boost I need to move on and keep my life going as planned! Good luck!! Thanks again.

--Dennest

Hi, Dennest,

I was diagnosed back in 1989. The melanoma was on my back. I had a wide excision to remove it with no other treatment. This happened six months before my wedding. My surgeon advised us to wait two years before becoming pregnant. We did exactly that. I went on to have three children. I am still seen regularly by a dermatologist.

 

The best to you,

Marian

DEnnest,

I have placed some information from the NIH below.  It is always a hard decision with imperfect data to guide us.  At stage 1 you might be okay but I would still discuss it with a melanoma specialist.  You have to take your own reproductive age into consideration.  If you are in your late 20's or early 30's you have time.  If you are in your mid thirties and beyond, you need to take overall fertility into consideration.

Hope it helps,

Kevin

 

Should women who previously were diagnosed with
melanoma avoid pregnancy?

The issue here is whether pregnancy activates micrometastatic
disease. There is no convincing evidence
that pregnancy activates or stimulates dormant micrometastatic
disease, although anecdotal case reports
certainly suggest that this may happen in some cases. One
of the difficulties in addressing this question is that it is
impossible to know prospectively which patients are harboring
micrometastases. One author noted similar fiveand
ten-year survival rates for 115 patients who were
pregnant with melanoma compared with 330 female
melanoma patients who were never pregnant during or after
their diagnosis.' The pregnant group, however, had a
higher frequency of lymph node involvement at the time
of diagnosis. A better survival was actually noted for 71
patients who were pregnant within a year before or five
years after a diagnosis of melanoma, but the control group
consisted of only 31 women who did not get pregnant
during a similar interval and who actually had higher
stage disease.47 In another study, women diagnosed with
melanoma before getting pregnant were compared with
women diagnosed after completing all pregnancies.39 The
latter group actually appeared to do worse at five years,
although statistical comparison was not provided. In a retrospective
study conducted at Duke University, 43
women with stage I melanoma who became pregnant
within the next five years had prognoses similar to those
of 337 women who did not get pregnant, both in terms of
relapse and disease-free survival.9
There is no evidence that nulliparous women as a
group differ from parous women as a group, in terms of
prognosis from the time of a subsequent diagnosis of
melanoma while pregnant. In a study that compared 85
women diagnosed with melanoma before their first pregnancy
with 143 women who had completed all pregnancies,
melanoma developed in 68 between pregnancies and
in 92 during pregnancy, and there was no difference in
these groups.39 Two other small studies also found no difference
in prognosis for nulliparous as opposed to parous
women,4M42 although the studies were small in scope. The
only trials that address the issue of the importance of subsequent
pregnancy on prognosis have failed to identify
parity as an important variable in multivariate analysis.39
In the absence of definitive data, many authorities have
recommended that women avoid pregnancy for two to
five years after a diagnosis of melanoma, mainly because
that is the time period during which most recurrences are
diagnosed.'944149 In one study, such patients who did become
pregnant were actually used as controls to compare
with patients who were being diagnosed with melanoma
for the first time while pregnant.37

Should women who previously were diagnosed with
melanoma during a pregnancy avoid subsequent pregnancy?
Historically, there has been great concern regarding
the risk of subsequent pregnancy in women who were initially
diagnosed with melanoma during a previous pregnancy,
based on the presumption that these melanomas in
particular may be influenced adversely by growth factors
and hormones secreted during pregnancy. Earlier observers
felt strongly that pregnancy worsened the prognosis
in this group of patients.2549 There is no objective
evidence that this group is at higher risk with subsequent
pregnancy, however. Despite this, the consensus is to recommend
the deferral of subsequent pregnancy for two to
three years in women in whom a primary melanoma developed
during pregnancy.7

Is there a risk of transplacental metastases to the fetus:?

There definitely is a risk of transplacental transmission
of melanoma from mother to fetus, but fortunately
this risk is low.  Placental involvement itself is indicative
of widespread hematogenous dissemination in the
mother, but placental involvement does not necessarily
mean that the newborn baby will have melanoma. Of 35
cases of placental or fetal involvement with cancer following
pregnancy, one study found that 11 were due to
melanoma, the most common cancer associated with this
phenomenon, followed by leukemia or lymphoma. Of
the 11 melanoma patients, the placenta was involved in 7
and the fetus in 6. Two of the infants with melanoma underwent
spontaneous regression of disease after delivery.
It has been suggested that only 25% of infants with placental
metastatic melanoma will actually die of metastatic
melanoma, and it is almost always manifest at the time
of delivery and then fails to regress spontaneously after
delivery. The implications of these observations are that
women diagnosed with metastatic melanoma during
pregnancy need not abort their fetus out of a fear of
transplacental spread, and active therapy for a fetus born
in the setting of placental metastases is not warranted.