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Case Report Open Access

Combined BRAF/MEK inhibition for BRAF‑mutant melanoma brain metastases in pregnancy: A case report

  • Authors:
    • Jaroslav Melus
    • Michaela Jezberova
    • Silvia Mikulajova
    • Katarina Komaromy Gerincova
    • Martin Karlik
    • Igor Straka
    • Marek Krivosik
    • Peter Valkovic
    • Gabriela Timarova
  • View Affiliations / Copyright

    Affiliations: 2nd Department of Neurology, Comenius University Bratislava, Faculty of Medicine, University Hospital Bratislava, Bratislava 833 05, Slovakia, Department of Magnetic Resonance Imaging, Dr. Magnet Ltd., Bratislava 833 05, Slovakia, Department of Neonatology, University Hospital Bratislava, Bratislava 833 05, Slovakia, 1st Department of Obstetrics and Gynecology, Slovak Medical University, University Hospital Bratislava, Bratislava 833 05, Slovakia
    Copyright: © Melus et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 8
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    Published online on: October 24, 2025
       https://doi.org/10.3892/ol.2025.15361
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Abstract

Melanoma is a highly aggressive malignancy with the potential to metastasize to the placenta and fetus. Pregnancy‑associated melanoma (PAM) complicated by brain metastases (MTS) is exceedingly rare, and its management requires balancing maternal survival with fetal safety. A 35‑year‑old pregnant woman with a history of superficial spreading melanoma presented at 24 weeks of gestation with multiple brain MTS. Following multidisciplinary consultation and after obtaining informed consent, two symptomatic brain MTS were surgically resected during pregnancy. Histopathology and immunohistochemistry confirmed metastatic melanoma, and molecular testing identified a B‑Raf proto‑oncogene serine/threonine kinase V600E mutation. Due to disease progression, targeted therapy with dabrafenib and trametinib was initiated in the third trimester. At 33 weeks of gestation, an acute cesarean section was performed following a focal impaired consciousness seizure. A premature male neonate was delivered, requiring respiratory support and intensive care. Following stabilization, the growth and psychomotor development of the neonate remained normal at follow‑up. Postpartum, the mother transitioned to immune checkpoint inhibitor therapy and remains alive with partial remission 16 months after the diagnosis of brain MTS. The present case demonstrates the feasibility of combined neurosurgical and targeted therapeutic approaches for PAM with brain MTS. The case provides valuable clinical and ethical insights into individualized decision‑making when managing advanced melanoma during pregnancy, a scenario that remains rare and poorly documented.
View Figures

Figure 1

Timeline of the clinical course. (A)
Left temporal lobe metastasis with perifocal edema (red arrow; CT
axial plane). (B) MRI longitudinal co-registered fusion of 3D
fluid-attenuated inversion recovery images showing rapid
enlargement of the right frontal metastasis (comparison of images a
week apart in January 2024). Scale bars, 10 mm.

Figure 2

Timeline of the radiological course
(MRI fluid-attenuated inversion recovery sequences). (Aa-Ad)
Initial images showing four malignant melanoma brain metastases
(red arrows). (Ae and Af) Images showing two suspected brain
metastases (red arrows). (Ba and Bb) MRI 2 days after surgical
resections. (Bc and Bd) Enlargement of the two remaining metastases
(red arrows). (Be) Growth of a new metastasis in the dominant
hippocampal region (red arrow). (Ca and Cb) Favorable postoperative
changes (red arrows). (Cc-Ce) Notable reduction in metastatic
lesion volume (red arrows). (Da and Db) Further favorable
postoperative changes without signs of recurrence (red arrows).
(Dc-De) Partial disease remission (red arrows). Scale bars, 10
mm.

Figure 3

WB-MRI, HRCT pulmonary scans and
pre-surgical brain mapping in relation to the left temporal
metastasis. (A) WB-MRI confirming the pulmonary nodule in the left
upper lobe (red arrow). (B) HRCT scan showing a lobulated pulmonary
nodule in the same region (red arrow; January 2024). (C) Pulmonary
nodule visible on CT in January 2023 (red arrow). (D) Placenta with
homogeneous appearance and no evidence of metastatic involvement
(red arrows; coronal T2-weighted image). (E) Diffusion tensor
imaging demonstrating major white matter tracts in proximity to the
lesion: Corticospinal tract (blue), inferior fronto-occipital
fasciculus (green), arcuate fasciculus (orange) and optic radiation
(yellow). (F) Tractography showing all major tracts, including the
uncinate fasciculus (red). (G) Functional MRI demonstrating
eloquent cortical areas relevant to speech (yellow); Wernicke's
area (red arrow), Broca's area (white arrow). Scale bars, 10 mm.
WB, whole-body; HRCT, high-resolution computed tomography.
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Copy and paste a formatted citation
Spandidos Publications style
Melus J, Jezberova M, Mikulajova S, Gerincova KK, Karlik M, Straka I, Krivosik M, Valkovic P and Timarova G: Combined BRAF/MEK inhibition for BRAF‑mutant melanoma brain metastases in pregnancy: A case report. Oncol Lett 31: 8, 2026.
APA
Melus, J., Jezberova, M., Mikulajova, S., Gerincova, K.K., Karlik, M., Straka, I. ... Timarova, G. (2026). Combined BRAF/MEK inhibition for BRAF‑mutant melanoma brain metastases in pregnancy: A case report. Oncology Letters, 31, 8. https://doi.org/10.3892/ol.2025.15361
MLA
Melus, J., Jezberova, M., Mikulajova, S., Gerincova, K. K., Karlik, M., Straka, I., Krivosik, M., Valkovic, P., Timarova, G."Combined BRAF/MEK inhibition for BRAF‑mutant melanoma brain metastases in pregnancy: A case report". Oncology Letters 31.1 (2026): 8.
Chicago
Melus, J., Jezberova, M., Mikulajova, S., Gerincova, K. K., Karlik, M., Straka, I., Krivosik, M., Valkovic, P., Timarova, G."Combined BRAF/MEK inhibition for BRAF‑mutant melanoma brain metastases in pregnancy: A case report". Oncology Letters 31, no. 1 (2026): 8. https://doi.org/10.3892/ol.2025.15361
Copy and paste a formatted citation
x
Spandidos Publications style
Melus J, Jezberova M, Mikulajova S, Gerincova KK, Karlik M, Straka I, Krivosik M, Valkovic P and Timarova G: Combined BRAF/MEK inhibition for BRAF‑mutant melanoma brain metastases in pregnancy: A case report. Oncol Lett 31: 8, 2026.
APA
Melus, J., Jezberova, M., Mikulajova, S., Gerincova, K.K., Karlik, M., Straka, I. ... Timarova, G. (2026). Combined BRAF/MEK inhibition for BRAF‑mutant melanoma brain metastases in pregnancy: A case report. Oncology Letters, 31, 8. https://doi.org/10.3892/ol.2025.15361
MLA
Melus, J., Jezberova, M., Mikulajova, S., Gerincova, K. K., Karlik, M., Straka, I., Krivosik, M., Valkovic, P., Timarova, G."Combined BRAF/MEK inhibition for BRAF‑mutant melanoma brain metastases in pregnancy: A case report". Oncology Letters 31.1 (2026): 8.
Chicago
Melus, J., Jezberova, M., Mikulajova, S., Gerincova, K. K., Karlik, M., Straka, I., Krivosik, M., Valkovic, P., Timarova, G."Combined BRAF/MEK inhibition for BRAF‑mutant melanoma brain metastases in pregnancy: A case report". Oncology Letters 31, no. 1 (2026): 8. https://doi.org/10.3892/ol.2025.15361
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