Malignant melanoma in pregnancy: Rarity and paucity
Published in the Tropical Journal of Obstetrics and Gynaecology, the authors report a case of a woman diagnosed with non- metastatic malignant melanoma in the first trimester of pregnancy with a successful outcome.

A 34-year-old healthy primigravida of 12 weeks gestation, married for 9 years, had presented to with verrucous posterior auricular lesion of 4 months duration, gradually increasing in size. The patient did not report any other illness and had not taken any medications. On examination, she had a 5 cm × 5 cm hemispherical posterior auricular mass, hard in consistency, well-defined borders, and irregular surface with no ulceration or bleeding with palpable hard mobile neck nodes.

An edge biopsy of the lesion was performed and histological examination described it as MM Clark level IV as the tumor cells were seen in deep dermis with no subcutaneous tissue involvement with no junctional activity in the overlying skin. MRI of the brain and neck revealed erosion of the underlying mastoid bone with a large exophytic lesion in the left occipitalis muscle and bilateral subcentimeter lymph nodes involvement in level 1A, 1B, 2A, 2B, and left-sided 5A node.

Abdominal ultrasound showed no evidence of metastasis. Chest radiography was circumvented due to her early gestational age and as there were no clinical evidence of metastasis. Target scan was done and anomalies were ruled out.

A team comprising the obstetrician, surgeon, oncologist, and plastic surgeon were consulted, and after a consensus on the treatment, she underwent wide local excision with left modified radical neck dissection with transposition flap reconstruction at 22 weeks of gestation, histology of which revealed it to be an invasive nodular MM with margins free of tumor, stage T4N1M0.

Since then, the patient was followed up carefully, antenatal period was uneventful, and at the 38th week of gestation she delivered a healthy 3.360-kg girl baby with an Apgar of 8/10 9/10 by emergency lower segment cesarean section due to severe oligohydramnios. The placenta examined was grossly normal and pathology revealed no metastasis. She has been disease-free for 6 months post-partum now.

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