Pregnancy in association with malignant melanoma
J.P. is a 35-year-old white female who presented in December 1988 with an irregular pigmented lesion on her right lower thigh and a palpable node in her right groin. Biopsy of the lesion showed an ulcerated, Clark Level 4. 2.7 mm malignant melanoma [Fig 1). At the time the patient was treated with a wide local excision of the primary site and a therapeutic right groin dissection. Pathology showed clear margins and 1/16 positive nodes. Her clinical course follows: 2/89 Immunotherapy with an experimental tumor cell vaccine. 1/91 Patient remarried, moved, and lost to follow-up. 11/92 Returned to the clinic 6 months pregnant. Ultrasound exam for pregnancy showed a 5.0- cm right iliac node. 12/92 Taken to the OR for a right iliac node dissection. Pathology showed 1/5 iliac nodes positive for metastatic melanoma. 2/93 Patient delivered a healthy baby boy. Metastatic melanoma present in the placenta (Fig 2). 3/93 The patient refuses any systemic therapy. 10/94 Presented with right axillary and left neck nodal metastases. CT scan of the abdomen and chest demonstrated retroperitoneal and mediastinal adenopathy (Stage 4 disease). 1/95 Patient being evaluated for 'gene' therapy program. Patient refuses systemic therapy. 4/95 Patient dies of metastatic melanoma. Son is alive and well at 2 years of age.