Pregnancy Complicated by Rapidly Progressing Vulvar Melanoma: A Case Study.

Abstract

BACKGROUND Vulvar melanoma during pregnancy is exceptionally rare. Hormonal and immunological changes in pregnancy have raised concerns about the potential for accelerated melanoma progression and poorer maternal outcomes. This case report describes an unusual presentation of vulvar melanoma in a pregnant patient, which rapidly progressed despite previous treatments, but resulted in a favorable fetal outcome. CASE REPORT A 40-year-old G3P2A0 woman at 28 weeks of gestation, with a history of vulvar malignant melanoma diagnosed 3 years prior, presented with sudden abdominal pain and hematuria. She had previously received 6 courses of chemotherapy. Physical examination revealed a 3-cm mass in the right vulva, while ultrasonography detected a hyperechoic solid mass in the cervix and elevated LDH levels. Given the advanced disease, the medical team proceeded with a cesarean hysterectomy, colpotomy for uterine corpus involvement, and bladder repair due to an iatrogenic laceration. Histopathological findings confirmed metastatic vulvar melanoma in the cervix and uterine corpus. The pregnancy was terminated at 27 weeks due to the progression of grade IV melanoma, but the neonate was delivered in stable condition. Unfortunately, the patient died 1 month after the operation. CONCLUSIONS This case underscores the potential for aggressive melanoma progression during pregnancy, likely exacerbated by physiological changes, yet highlights a successful fetal outcome. While chemotherapy can adversely affect the reproductive system and may lead to infertility, this patient was able to conceive, and the case illustrates the complex interplay of pregnancy and cancer progression.