Women diag­nosed with melanoma may require coun­sel­ing for fer­til­ity preser­va­tion, fer­til­ity treat­ment and safety of preg­nancy after treat­ment. Melanoma is one of the most com­mon can­cers in young adults in the United States. In the US and world­wide, there is  dra­matic increase in the inci­dence  of skin melanomas. Approx­i­mately 30,000 women are expected to be diag­nosed with melanoma in 2010, one third will be in their repro­duc­tive years. Its the most com­mon can­cer in young adults 25 to 29 year old. Its more com­mon in white women com­pared to African Amer­i­cans and His­pan­ics.  Approx­i­mately  10% of melanomas run in fam­i­lies or are genet­i­cally inher­ited. Treat­ment of melanoma requires surgery. In advanced melanoma, chemother­apy is added. Dacarbazine-DTIC is an alky­lat­ing agent used for treat­ing melanomas. Immune ther­apy is also used for advanced melanomas– inter­feron α or IL-2.

In early stages, surgery is the only required treat­ment. In advanced stages if chemother­apy is used, ovar­ian reserve may be dimin­ished and this may reduce woman’s abil­ity to get preg­nant. The use of immune ther­apy is not known to affect future fer­til­ity. The effects of newer tar­geted ther­a­pies and vac­cines on fer­til­ity are also unknown.

Melanoma and fer­til­ity treat­ment. The estro­gen recep­tors were found on melanoma cells. Some researchers detected no sig­nif­i­cant increase in the risk of melanoma after treat­ment with fer­til­ity drugs, except pos­si­bly slight increase in risk in women who deliv­ered chil­dren before. The rela­tion­ship between estro­gen expo­sure and melanoma is con­tro­ver­sial. Women seek­ing fer­til­ity preser­va­tion before expo­sure to chemother­apy or melanoma sur­vivors desir­ing preg­nancy after com­plet­ing treat­ment should con­sult with a fer­til­ity preser­va­tion spe­cial­ist about the risks and ben­e­fits of fer­til­ity treat­ment and the safety of preg­nancy. The ovar­ian stim­u­la­tion reg­i­men can also be mod­i­fied to min­i­mize estro­gen expo­sure. It may also be pos­si­ble for women with inher­ited pre­dis­po­si­tion to melanoma to avoid trans­mis­sion to future chil­dren through test­ing of embryos-PGD.

Melanoma and preg­nancy. Ten stud­ies includ­ing 5600 women found that preg­nancy does not reduce sur­vival in women diag­nosed with melanoma. Women treated for melanoma who sub­se­quently became preg­nant were not adversely affected com­pared to women who did not get preg­nant after treat­ment. For thin tumors-<1.5mm most experts do not rec­om­mend defer­ring preg­nancy. For thicker tumors, physi­cians may rec­om­mend defer­ring preg­nancy for two years as most recur­rences take place dur­ing that inter­val. Read more at http://nycivf.org