Medium Sized Congenital Melanocytic Nevus with Suspected Progression to Melanoma during Pregnancy: What’s the Best for the Patient?
DOI:
https://doi.org/10.3889/oamjms.2018.016Keywords:
Congenital melanocytic nevus (CMN), Pregnancy, Melanoma, Malignant transformationAbstract
BACKGROUND: Congenital melanocytic nevi (CMN) are pigmented skin lesions usually present at birth. Rare varieties can develop and become clinically very large. Although they are benign nevomelanocytic neoplasms, all CMN may be precursors of the melanoma, regardless of their size. Individual risk of malignant transformation of melanocyte is determined by simultaneous action of exogenous and endogenous factors. The major exogenous risk factor is ultraviolet radiation. Leading roles among the endogenous factors are attributed to skin phenotype, gene mutation, sex hormones and their significance.
CASE REPORT: We present a case of a 27 – year - old pregnant female patient with a congenital melanocytic nevus, which increased significantly in size, during her pregnancy. Estrogen levels increase during pregnancy and clinical evidence has suggested that melanocytes are estrogen - responsive. Nevi in a pregnant patient would exhibit increased expression of estrogen receptor β (ERβ) and thus enhanced the potential to respond to altered estrogen levels.
CONCLUSION: All pigmented skin lesions should be carefully observed during pregnancy by a dermatologist due to the increased risk of malignant transformation, associated with the endocrine dependence. All lesions with visible changes should be removed surgically with appropriative anaesthesia.
Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Eds. Bolognia J, Jorizzo J, Schaffer J, Dermatology 3rd ed. Elsevier Sanders. 2012; P 1871-6.
Viana ACL, Gontijo B, Bittencourt FV. Giant congenital melanocytic nevus. An Bras Dermatol. 2013; 88(6): 863-78. https://doi.org/10.1590/abd1806-4841.20132233 PMid:24474093 PMCid:PMC3900335
Chokoeva AA, Fioranelli M, Roccia MG, Lotti T, Wollina U, Tchernev G. Giant congenital melanocytic nevus in a bulgarian newborn. J Biol Regul Homeost Agents. 2016; 30(2 Suppl 2): 57-60. PMid:27373137
Goldman A, Wollina U, Tchernev G, Chokoeva AA, Lotti T. Medium-sized congenital melanocytic nevus of the forehead, glabella and temple – surgical treatment and long-term follow-up. J Biol Regul Homeost Agents. 2016; 30(2 Suppl 2): 53-8. PMid:27373136
Chokoeva AA, Tchernev G, Trayanova E, Patterson JW, Lotti T, Wollina U. Giant congenital melanocytic nevus localized in the axillary area: serial excisions as optimal treatment option. J Biol Regul Homeost Agents. 2015; 29(1 Suppl):123-8. PMid:26016980
Chokoeva A, Tchernev G. [Significance of the clinical and dermatoscopic findings, histopathology and reflex confocal microscopy (RCM) in determining the origin of melanocytic lesions: an analysis based on a clinical case]. Akush Ginekol (Sofiia). 2014; 53(6):56-62.
Trayanova E, Chokoeva AA, Tchernev G, Patterson JW, Wollina U, Lotti T. Dysplastic nevi, melanoma and pregnancy- where is the relationship? J Biol Regul Homeost Agents. 2015; 29(1 Suppl): 87-90. PMid:26016974
Daryanani D, Plukker JT, De Hullu JA, Kuiper H, Nap RE, Hoekstra HJ, Pregnancy and early- stage melanoma, Cancer. 2003; 97: 2248-53. https://doi.org/10.1002/cncr.11321 PMid:12712479
Brenner S, Tamir E. Early detection of melanoma: the best strategy for a favorable prognosis. Clin Dermatol. 2002; 20(3): 203-11. https://doi.org/10.1016/S0738-081X(02)00233-X
Neil SM, Eves P, Richardson B, Molife R, Lorigan P, Wagner M, Layton C, Morandini R, Ghanem G. Oestrogenic steroids and melanoma cells influence invasion of melanoma cells in vitro. Pigment Cell Res. 2000; (13S8): 68-72.
Pennoyer JW, Grin CM, Driscoll MS, et al. Changes in size of melanocytic nevi during pregnancy. J Am Acad Dermatol. 1997; 36: 378-382. https://doi.org/10.1016/S0190-9622(97)80212-5
de Giorgi V, Gori A, Grazzini M, Rossari S, Scarfi F, Corciova S, Verdelli A, Lotti T, Massi D. Estrogens, estrogen receptors and melanoma. Expert Rev Anticancer Ther. 2011; 11(5):739-47. https://doi.org/10.1586/era.11.42 PMid:21554049
Grill HJ, Benes P, Manz B, Schramm P, Morsches B, Korting GW, Pollow K. Steroid hormone receptors in human melanoma. Arch Dermatol Res. 1982; 272:97-101. https://doi.org/10.1007/BF00510399 PMid:7165327
Folkerd EJ, Downsett M. Influence of sex hormones on cancer progression. J Clin Oncol. 2010; 28:4038-44. https://doi.org/10.1200/JCO.2009.27.4290 PMid:20644089
Schmidt AN, Nanney LB, Boyd AS, King LE, Jr, Ellis DL. Oestrogen receptor- beta expression in melanocytic lesion. Exp Dermatol. 2006; 15: 971-780. https://doi.org/10.1111/j.1600-0625.2006.00502.x PMid:17083364
Kincannon J, Boutzale C. The physiology of pigmented nevi. Pediatrics. 1999; 104:1042-1045. PMid:10506262
Krengel S. Nevogenesis- new thoughts regarding a classical problem. Am J Dermatopathol. 2005; 27:456-465. https://doi.org/10.1097/01.dad.0000175532.27368.3f PMid:16148419
Slominski A, Wortsman J, Tuckey RC, Paus R. Differential expression of HPA axis homolog in the skin. Mol Cell Endocrinol. 2007; 266:143-149. https://doi.org/10.1016/j.mce.2006.12.012 PMid:17197073 PMCid:PMC1839836
De Giorgi V, Mavilia C, Massi D, et al. Estrogen receptor expression in cutaneo us melanoma: a real- time reverse transcriptase-polymerase chain reaction and immunohistochemical study. Arch Dermatol. 2009; 145:30-6. https://doi.org/10.1001/archdermatol.2008.537 PMid:19153340
De Giorgi V, Gori A, Gandini S, et al. Estrogen receptor beta and melanoma. A comparative study. Br J Dermatol. 2013; 168:513-9. https://doi.org/10.1111/bjd.12056 PMid:23013061
Rampen F. Malignant melanoma: sex differences in survival after evidence of distant metastasis. Br J Cancer. 1980; 42(1):52-7. https://doi.org/10.1038/bjc.1980.202 PMid:7426329 PMCid:PMC2010477
Smith MA, Fine JA, Barnhill RL, Berwick M. Hormonal and reproductive influences and risk of melanoma in women. Int J Epidemiol. 1998; 27(5):751-7. https://doi.org/10.1093/ije/27.5.751 PMid:9839729
Piris A, Mihm MC Jr, Hoang MP, BAP1 and BRAFV600E expression in benign and malignant melanocytic proliferation. Hum. Pathol. 2015; 46(2):239-45. https://doi.org/10.1016/j.humpath.2014.10.015 PMid:25479927
Wang A, Papneja A, Hyrcza M, Al-Habeeb A, Ghazarian D, Gene of the month: BAP1. J Clin Patol. 2016; 69(9):750-3. https://doi.org/10.1136/jclinpath-2016-203866 PMid:27235536
Busam KJ, Sung J, Wiesner T, von Deimling A, Jungbluth A. Combined BRAF(V600E)-positive melanocytic lesions with large epithelioid cells lacking BAP1 expression and conventional nevomelanocytes. Am J Surg Pathol. 2013; 37(2):193-9. https://doi.org/10.1097/PAS.0b013e318263648c PMid:23026932
Trayanov I, Trayanova E, Chokoeva A, Tchernev G. [Congenital melanocytic nevus of the shoulder with rapid growth progression during pregnancy. Successful surgical approach]. Akush Ginekol (Sofiia). 2015; 54(8):51-6.
Trayanova E, Trayanov I, Chokoeva A, Tchernev G. [Malignant melanoma--the influence of hormonal factors on the progression and prognosis. Comparative analysis based on two clinical cases]. Akush Ginekol (Sofiia). 2015; 54(7):45-51.
Downloads
Published
How to Cite
Issue
Section
License
http://creativecommons.org/licenses/by-nc/4.0