Skip to main content

Advertisement

Log in

Sentinel Lymph Node Biopsy for Melanoma in Pregnant Women

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The incidence of melanoma is rising in young women of childbearing age. Melanoma diagnosed during pregnancy presents unique challenges. This study was conducted to determine the effect of sentinel lymph node biopsy (SLNB) for melanoma on maternal and fetal outcomes in pregnant women.

Methods

A prospective melanoma database was retrospectively queried for women diagnosed with melanoma during or immediately before pregnancy as well as SLNB in pregnant women. The outcomes of SLNB for the mothers and fetuses were evaluated.

Results

Fifteen pregnant women underwent wide local excision (WLE) and SLNB for melanoma from 1997 to 2012. The median gestational age was 20 weeks. More than half of the women noticed changes in the primary melanoma lesion during the pregnancy. The median Breslow thickness was 1.00 mm. Lymphatic mapping and SLNB were performed with some combination of radiocolloid or vital blue dye without adverse effects. Three patients had micrometastatic disease and underwent a completion lymphadenectomy. Sixteen children were born at a median gestational age of 39 weeks. The median 1- and 5-minute Apgar scores were 8 and 9, respectively. At a median follow-up of 54.4, months none of the patients had experienced recurrence, and all children were healthy and free of melanoma.

Conclusions

In this series of pregnant women with melanoma, SLNB was performed safely during pregnancy without adverse effects to the mothers and fetuses. We recommend that clinicians explain the risks and benefits of the SLNB procedure to pregnant women so an informed decision can be made about the procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Ferenc Czeyda-Pommersheim, Harriet Kluger, … Margarita Revzin

References

  1. American Cancer Society. Melanoma Skin Cancer Overview. Revised January 23, 2012. http://www.cancer.org/acs/groups/cid/documents/webcontent/003063-pdf.pdf (January 23, 2012).

  2. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62:10–29.

    Article  PubMed  Google Scholar 

  3. Purdue MP, Freeman LE, Anderson WF, Tucker MA. Recent trends in incidence of cutaneous melanoma among U.S. Caucasian young adults. J Invest Dermatol. 2008;128:2905–8.

    Article  PubMed  CAS  Google Scholar 

  4. Schwartz JL, Mozurkewich EL, Johnson TM. Current management of patients with melanoma who are pregnant, want to get pregnant, or do not want to get pregnant. Cancer. 2003;97:2130–3.

    Article  PubMed  Google Scholar 

  5. Balch CM, Gershenwald JE, Soong SJ, Thompson JF. Update on the melanoma staging system: the importance of sentinel node staging and primary tumor mitotic rate. J Surg Oncol. 2011;104:379–85.

    PubMed  Google Scholar 

  6. Morton DL, Thompson JF, Cochran AJ, et al. MSLT Group. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355:1307–17.

    Article  PubMed  CAS  Google Scholar 

  7. National Comprehensive Cancer Network. NCCN guidelines, melanoma. Version 3. 2012.

  8. Andtbacka RH, Gershenwald JE. Role of sentinel lymph node biopsy in patients with thin melanoma. J Natl Compr Canc Netw. 2009;7:308–17.

    PubMed  Google Scholar 

  9. Khera SY, Kiluk JV, Hasson DM, et al. Pregnancy-associated breast cancer patients can safely undergo lymphatic mapping. Breast J. 2008;14:250–4.

    Article  PubMed  Google Scholar 

  10. Mondi MM, Cuenca RE, Ollila DW, Stewart JH IV, Levine EA. Sentinel lymph node biopsy during pregnancy: initial clinical experience. Ann Surg Oncol. 2007;14:218–21.

    Article  PubMed  Google Scholar 

  11. Gentilini O, Cremonesi M, Toesca A, et al. Sentinel lymph node biopsy in pregnant patients with breast cancer. Eur J Nucl Med Mol Imaging. 2010;37:78–83.

    Article  PubMed  Google Scholar 

  12. Gentilini O, Cremonesi M, Trifirò G, et al. Safety of sentinel node biopsy in pregnant patients with breast cancer. Ann Oncol. 2004;15:1348–51.

    Article  PubMed  CAS  Google Scholar 

  13. Lewis KD, Gonzalez R, Robinson WA, Fitzpatrick JE, McCarter MD, Braden C. A young woman with melanoma diagnosed during pregnancy. Oncology (Williston Park). 2004;18:794–9.

    Google Scholar 

  14. Broer N, Buonocore S, Goldberg C, et al. A proposal for the timing of management of patients with melanoma presenting during pregnancy. J Surg Oncol. 2012;106:36–40.

    Article  PubMed  Google Scholar 

  15. U.S. Census Bureau. American community survey 2008 (table S1301) and special tabulations. http://www.census.gov/hhes/fertility/data/cps/2008.html (January 30, 2012).

  16. Alexander A, Samlowski WE, Grossman D, et al. Metastatic melanoma in pregnancy: risk of transplacental metastases in the infant. J Clin Oncol. 2003;21:2179–86.

    Article  PubMed  Google Scholar 

  17. Alexander A, Harris RM, Grossman D, Bruggers CS, Leachman SA. Vulvar melanoma: diffuse melanosis and metastasis to the placenta. J Am Acad Dermatol. 2004;50:293–8.

    Article  PubMed  Google Scholar 

  18. Thompson JA. The revised American Joint Committee on Cancer staging system for melanoma. Semin Oncol. 2002;29:361–9.

    Article  PubMed  Google Scholar 

  19. Balch CM, Gershenwald JE, Soong SJ, et al. Final version of the 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27:6199–206.

    Article  PubMed  Google Scholar 

  20. Apgar V. Proposal for new method of evaluation of newborn infant. Anesth Analg. 1953;32:260–7.

    Article  CAS  Google Scholar 

  21. Casey BM, McIntire DD, Leveno KJ. The continuing value of the Apgar score for the assessment of newborn infants. N Engl J Med. 2001;344:467–71.

    Article  PubMed  CAS  Google Scholar 

  22. Walton NKD, Melachuri VK. Anaesthesia for non-obstetric surgery during pregnancy. Contin Educ Anaesth Crit Care Pain. 2006;6:83–5.

    Article  Google Scholar 

  23. Karakousis CP, Driscoll DL. Groin dissection in malignant melanoma. Br J Surg. 1994;81:1771–4.

    Article  PubMed  CAS  Google Scholar 

  24. Morita ET, Chang J, Leong SPL. Principles and controversies in lymphoscintigraphy with emphasis on breast cancer. Surg Clin North Am. 2000;80:1721–39.

    Article  PubMed  CAS  Google Scholar 

  25. Cimmino VM, Brown AC, Szocik JF, et al. Allergic reactions to isosulfan blue during sentinel node biopsy—a common event. Surgery. 2001;130:439–42.

    Article  PubMed  CAS  Google Scholar 

  26. Montgomery LL, Thorne AC, Van Zee KJ, et al. Isosulfan blue dye reactions during sentinel lymph node mapping for breast cancer. Anesth Analg. 2002;95:385–8.

    PubMed  Google Scholar 

  27. Raut CP, Hunt KK, Akins JS, et al. Incidence of anaphylactoid reactions to isosulfan blue dye during breast carcinoma lymphatic mapping in patients treated with preoperative prophylaxis: results of a surgical prospective clinical practice protocol. Cancer. 2005;104:692–9.

    Article  PubMed  CAS  Google Scholar 

  28. Wilke LG, McCall LM, Posther KE, et al. Surgical complications associated with sentinel lymph node biopsy: results from a prospective international cooperative group trial. Ann Surg Oncol. 2006;13:491–500.

    Article  PubMed  Google Scholar 

  29. Komenaka IK, Bauer VP, Schnabel FR, et al. Allergic reactions to isosulfan blue in sentinel lymph node mapping. Breast J. 2005;11:70–2.

    Article  PubMed  Google Scholar 

  30. Leong SP, Donegan E, Heffernon W, Dean S, Katz JA. Adverse reactions to isosulfan blue during selective sentinel lymph node dissection in melanoma. Ann Surg Oncol. 2000;7:361–6.

    Article  PubMed  CAS  Google Scholar 

  31. Bézu C, Coutant C, Salengro A, Daraï E, Rouzier R, Uzan S. Anaphylactic response to blue dye during sentinel lymph node biopsy. Surg Oncol. 2011;20:e55–9.

    Article  PubMed  Google Scholar 

  32. Cragen JD. Teratogen update: methylene blue. Teratology. 1999;60:42–8.

    Article  Google Scholar 

  33. Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127:392–9.

    Article  PubMed  CAS  Google Scholar 

  34. Gershenwald JE, Tseng CH, Thompson W, Mansfield PF, Lee JE, Bouvet M. Improved sentinel lymph node localization in patients with primary melanoma with the use of radiolabeled colloid. Surgery. 1998;124:203–10.

    Article  PubMed  CAS  Google Scholar 

  35. McMasters KM, Wong SL, Edwards MJ, et al. Factors that predict the presence of sentinel lymph node metastasis in patients with melanoma. Surgery. 2001;130:151–6.

    Article  PubMed  CAS  Google Scholar 

  36. McMasters KM, Reintgen DS, Ross MI, et al. Sentinel lymph node biopsy for melanoma: how many radioactive nodes should be removed? Ann Surg Oncol. 2001;8:192–97.

    Article  PubMed  CAS  Google Scholar 

  37. Andtbacka RHI, Grissom CB, Boucher K, et al. Fluorescein identifies sentinel lymph nodes safely and precisely in patients with stage I and II cutaneous melanoma. The 7th International Sentinel Node Society meeting, Yokohama, Japan, November 19, 2010.

  38. Loibl S, von Minckwitz G, Gwyn K, et al. Breast carcinoma during pregnancy. International recommendations from an expert meeting. Cancer. 2006;15;106:237–46.

    Article  Google Scholar 

  39. Chan MP, Chan MM, Tahan SR. Melanocytic nevi in pregnancy: histologic features and Ki-67 proliferation index. J Cutan Pathol. 2010;37:843–51.

    Article  PubMed  Google Scholar 

  40. O’Meara AT, Cress R, Xing G, Danielsen B, Smith LH. Malignant melanoma in pregnancy. A population-based evaluation. Cancer. 2005;103:1217–26.

    Article  PubMed  Google Scholar 

  41. Gandini S, Iodice S, Koomen E, Di Pietro A, Sera F, Caini S. Hormonal and reproductive factors in relation to melanoma in women: current review and meta-analysis. Eur J Cancer. 2011;47:2607–17.

    Article  PubMed  CAS  Google Scholar 

  42. Jhaveri MB, Driscoll MS, Grant-Kels JM. Melanoma in pregnancy. Clin Obstet Gynecol. 2011;54:537–45.

    Article  PubMed  Google Scholar 

  43. Aloia TA, Gershenwald JE, Andtbacka RH, et al. Utility of computed tomography and magnetic resonance imaging staging before completion lymphadenectomy in patients with sentinel lymph node–positive melanoma. J Clin Oncol. 2006;24:2858–65.

    Article  PubMed  Google Scholar 

  44. Hauschild A, Gogas H, Tarhini A, et al. Practical guidelines for the management of interferon-alfa-2b side effects in patients receiving adjuvant treatment for melanoma. Cancer. 2008;112:982–93.

    Article  PubMed  CAS  Google Scholar 

  45. MacKie RM, Bufalino R, Morabito A, Sutherland C, Cascinelli N. Lack of effect of pregnancy on outcome of melanoma. Lancet. 1991;337:653–5.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

We thank Kelly Mead, Devonné Navez, and Marianne Bowling for data collection assistance and Lisa A. Tushla, PhD, for editorial assistance. We also thank CCSG/share resource support for financial assistance for manuscript development.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Robert H. I. Andtbacka MD, CM.

Additional information

Presented in part at the World Melanoma Congress, Vienna, Austria, May 12–16, 2009.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Andtbacka, R.H.I., Donaldson, M.R., Bowles, T.L. et al. Sentinel Lymph Node Biopsy for Melanoma in Pregnant Women. Ann Surg Oncol 20, 689–696 (2013). https://doi.org/10.1245/s10434-012-2633-7

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-012-2633-7

Keywords

Navigation