Metastatic melanoma in pregnancy

Risk of transplacental metastases in the infant

April Alexander, Wolfram E. Samlowski, Douglas Grossman, Carol S. Bruggers, Ronald M. Harris, John J. Zone, R. Dirk Noyes, Glen M. Bowen, Sancy Leachman

Research output: Contribution to journalArticle

170 Citations (Scopus)

Abstract

Purpose: Although metastases to the fetus via the placenta are rare, melanoma is the most common culprit. When it occurs, maternally derived melanoma metastasis in the infant is almost invariably fatal. Patients and Methods: This article reviews current guidelines for placental evaluation in pregnant women with metastatic melanoma and presents surveillance recommendations for their infants. Comprehensive literature reviews were performed on melanoma in pregnancy and melanoma metastasis to the placenta and fetus. The use of Interferon alfa in the pediatric population was also reviewed. A comprehensive search of the MEDLINE database (1966 to 2002) was performed. Articles were reviewed and additional references were obtained from the bibliographies. Translation of non-English articles was performed, and authors of previous publications were contacted. Results: Eighty-seven patients with placental or fetal metastasis were identified. Twenty-seven occurrences were attributed to melanoma (31%). The fetus was affected in six of 27 melanoma patients (22%), with five of six infants dying of disease. The use of high-dose Interferon alfa adjuvant therapy in pediatric patients has not been reported. Conclusion: The placentas of women with known or suspected metastatic melanoma should be carefully examined grossly and histologically by pathologists. With placental involvement, fetal risk of melanoma metastasis is approximately 22%. Neonates delivered with concomitant placental involvement should be considered a high-risk population. The risk-benefit ratio of adjuvant treatment for a potentially affected infant should be carefully weighed.

Original languageEnglish (US)
Pages (from-to)2179-2186
Number of pages8
JournalJournal of Clinical Oncology
Volume21
Issue number11
DOIs
StatePublished - Jun 1 2003
Externally publishedYes

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Melanoma
Neoplasm Metastasis
Pregnancy
Placenta
Fetus
Interferon-alpha
Pediatrics
Bibliography
MEDLINE
Population
Pregnant Women
Odds Ratio
Newborn Infant
Databases
Guidelines
Therapeutics

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Alexander, A., Samlowski, W. E., Grossman, D., Bruggers, C. S., Harris, R. M., Zone, J. J., ... Leachman, S. (2003). Metastatic melanoma in pregnancy: Risk of transplacental metastases in the infant. Journal of Clinical Oncology, 21(11), 2179-2186. https://doi.org/10.1200/JCO.2003.12.149

Metastatic melanoma in pregnancy : Risk of transplacental metastases in the infant. / Alexander, April; Samlowski, Wolfram E.; Grossman, Douglas; Bruggers, Carol S.; Harris, Ronald M.; Zone, John J.; Noyes, R. Dirk; Bowen, Glen M.; Leachman, Sancy.

In: Journal of Clinical Oncology, Vol. 21, No. 11, 01.06.2003, p. 2179-2186.

Research output: Contribution to journalArticle

Alexander, A, Samlowski, WE, Grossman, D, Bruggers, CS, Harris, RM, Zone, JJ, Noyes, RD, Bowen, GM & Leachman, S 2003, 'Metastatic melanoma in pregnancy: Risk of transplacental metastases in the infant', Journal of Clinical Oncology, vol. 21, no. 11, pp. 2179-2186. https://doi.org/10.1200/JCO.2003.12.149
Alexander A, Samlowski WE, Grossman D, Bruggers CS, Harris RM, Zone JJ et al. Metastatic melanoma in pregnancy: Risk of transplacental metastases in the infant. Journal of Clinical Oncology. 2003 Jun 1;21(11):2179-2186. https://doi.org/10.1200/JCO.2003.12.149
Alexander, April ; Samlowski, Wolfram E. ; Grossman, Douglas ; Bruggers, Carol S. ; Harris, Ronald M. ; Zone, John J. ; Noyes, R. Dirk ; Bowen, Glen M. ; Leachman, Sancy. / Metastatic melanoma in pregnancy : Risk of transplacental metastases in the infant. In: Journal of Clinical Oncology. 2003 ; Vol. 21, No. 11. pp. 2179-2186.
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abstract = "Purpose: Although metastases to the fetus via the placenta are rare, melanoma is the most common culprit. When it occurs, maternally derived melanoma metastasis in the infant is almost invariably fatal. Patients and Methods: This article reviews current guidelines for placental evaluation in pregnant women with metastatic melanoma and presents surveillance recommendations for their infants. Comprehensive literature reviews were performed on melanoma in pregnancy and melanoma metastasis to the placenta and fetus. The use of Interferon alfa in the pediatric population was also reviewed. A comprehensive search of the MEDLINE database (1966 to 2002) was performed. Articles were reviewed and additional references were obtained from the bibliographies. Translation of non-English articles was performed, and authors of previous publications were contacted. Results: Eighty-seven patients with placental or fetal metastasis were identified. Twenty-seven occurrences were attributed to melanoma (31{\%}). The fetus was affected in six of 27 melanoma patients (22{\%}), with five of six infants dying of disease. The use of high-dose Interferon alfa adjuvant therapy in pediatric patients has not been reported. Conclusion: The placentas of women with known or suspected metastatic melanoma should be carefully examined grossly and histologically by pathologists. With placental involvement, fetal risk of melanoma metastasis is approximately 22{\%}. Neonates delivered with concomitant placental involvement should be considered a high-risk population. The risk-benefit ratio of adjuvant treatment for a potentially affected infant should be carefully weighed.",
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