Combined BRAF/MEK inhibition for BRAF‑mutant melanoma brain metastases in pregnancy: A case report

Melanoma is a highly aggressive malignancy with the potential to metastasize to the placenta and fetus. Pregnancy-associated melanoma (PAM) complicated by brain metastases (MTS) is exceedingly rare, and its management requires balancing maternal survival with fetal safety. A 35-year-old pregnant woman with a history of superficial spreading melanoma presented at 24 weeks of gestation with multiple brain MTS. Following multidisciplinary consultation and after obtaining informed consent, two symptomatic brain MTS were surgically resected during pregnancy. Histopathology and immunohistochemistry confirmed metastatic melanoma, and molecular testing identified a B-Raf proto-oncogene serine/threonine kinase V600E mutation. Due to disease progression, targeted therapy with dabrafenib and trametinib was initiated in the third trimester. At 33 weeks of gestation, an acute cesarean section was performed following a focal impaired consciousness seizure. A premature male neonate was delivered, requiring respiratory support and intensive care. Following stabilization, the growth and psychomotor development of the neonate remained normal at follow-up. Postpartum, the mother transitioned to immune checkpoint inhibitor therapy and remains alive with partial remission 16 months after the diagnosis of brain MTS. The present case demonstrates the feasibility of combined neurosurgical and targeted therapeutic approaches for PAM with brain MTS. The case provides valuable clinical and ethical insights into individualized decision-making when managing advanced melanoma during pregnancy, a scenario that remains rare and poorly documented.