Surgical Management of Pregnancy Associated Melanoma: a Single Institution Experience with thirty-two pregnant patients

Background: Pregnancy-associated melanoma (PAM) is generally associated with a worse outcome but the prognostic role of pregnancy remains controversial [1] [2].Surgical approach to melanoma during pregnancy is challenging and there are no established guidelines.Delays in detection and treatment during pregnancy are common and may influence prognosis negatively.Safety of Sentinel Node Biopsy (SNB) during pregnancy is still argument of debate and one of the major concerns of physicians.We present our experience in management of PAM.Methods: A series of 32 pregnant women surgically treated for cutaneous melanoma at Istituto Nazionale dei Tumori, Milan, Italy, from 2007 to 2022 was retrospectively reviewed.Results: During pregnancy -from 7 th to 32 nd week of gestational age (GA) -30 patients had a histopathological diagnosis of invasive primary melanoma, while two had a regional nodal recurrence.Twenty-six women (81.2%) received surgical treatment during pregnancy, six (18,7%) were treated after delivery, because diagnosis occurred after 30 th week of GA.Twenty-seven women (84.3%) received wide excision and SNB during pregnancy or after delivery; three patients (9.3%) were not offered SNB because the procedure was considered dangerous for fetus and risk of miscarriage, and came at our observation with clinical nodal disease.Eleven woman (34.4%) presented with an advanced melanoma at diagnosis (10 stage III, 1 stage IV, M1a); the other 21 (65.6%) had a negative SN (7 stage IA, 8 stage IB, 3 stage IIA, 1 stage IIB, 2 stage IIC according to AJCC VIII Edition).No fetal complications occurred.Median follow up was 61 months.Twenty-four women (75%) were alive without evidence of disease, one (3.1%)was alive with disease (stage IV), and seven (21.9%) died of disease.Conclusions: Our study showed that SNB can be safely performed during pregnancy after the first trimester without fetal complications and should be offered to pregnant patients.Surgical treatment may be performed during pregnancy without delays since it provides accurate staging and higher prognostic chances.Our data were similar to other analyses and emphasized that pregnant women present a more advanced stage at diagnosis.According to our series we conclude that one possible explanation of the more advanced stage during pregnancy could be the delay or postponing adequate surgical treatment affecting prognosis.In order to study the real impact of pregnancy on melanoma prognosis larger series of patients are needed.