Malignant melanoma of the ovary and exposure to clomiphene citrate: A casereport and review of the literature

OBJECTIVE: The purpose of this article is to present a case of metastatic m alignant melanoma of the ovary, a review of the current literature, and cur rent recommendations for preventative and consultative management. STUDY DESIGN: This is a case report and literature review. A 34-year-old wo man had symptoms of pelvic abscess 1 month after clomiphene citrate stimula tion for infertility. After a failed course of antibiotic therapy, an explo ratory laparotomy was performed. Bilateral malignant melanomas of the ovary were discovered. The patient died 4 weeks later of disseminated metastases . Retrospectively, a history of a "mole" with unknown histopathologic chara cteristics had been removed from her arm 15 years earlier. A review of the literature was performed to provide current findings regarding malignant me lanomas of the ovary, as well as to evaluate the potential relationship bet ween the use of ovarian stimulating drugs and the development of melanomas. RESULTS: Melanomas account for 3% of cancers, but the incidence of melanoma is rising. Genital melanomas are uncommon; the primary site is the vulva. Primary malignant melanoma of the ovary is rare; however, delayed recurrenc e from a primary skin site with metastasis to the ovary is documented. The literature suggests a possible relationship between the use of clomiphene c itrate and an increase in melanomas of the skin. CONCLUSION: The gynecologist, as a primary provider, must be aware of the i ncreasing incidence of malignant melanoma, as well as the recommendations f or prevention. The gynecologist, as a consultant, must be aware of the risk of delayed recurrence of malignant melanoma. The potential for development of melanomas associated with the use of ovarian stimulation for infertilit y needs further monitoring and analysis.