SEER Inquiry System - Search

A patient had posterior cervical lymphadenopathy status post biopsy and subsequent lymph node dissection showed metastatic melanoma in 2018. Workup showed no skin lesions or primary site. Final diagnosis is melanoma of unknown primary (unknown if cutaneous or non-cutaneous). Should C760 be used as the primary site for this case since the histology codes of 8700-8790 are included in the Cervical Lymph Nodes and Unknown Primary Tumors of the Head and Neck schema in SEER*RSA?

The pathology report says: Right knee tumor:

A. discrete subcutaneous mass 3.5x5.2x1.4 cm malignant spindle cell neoplasm (see Comment)

B. A focus of subcutaneous malignant neoplasm is identified in the superior resection margin.

C.All other margins are clear.

The comment mentions that the specimen has been sent to Mayo Clinic and the Mayo clinic consult says, "we still believe that the diagnosis of spindle cell carcinoma is correct. Obviously the differential diagnosis involves melanoma and sarcoma also. The results of the immunoperoxidase stains strongly support the prior diagnosis of a carcinoma."

The previous SEER Program Coding and Staging Manual included Appendix C that has Coding Guidelines for some sites. The breast guidelines specifically instructed one to code the subsite with the invasive tumor when the pathology report identifies invasive tumor in one subsite and in situ tumor in a different subsite or subsites. The current Breast Solid Tumor Rules Table 1: Primary Site Codes refers one back to the SEER Manual and COC Manual for a source document priority list but does not make mention of invasive vs. in situ on that final version of the source document.

In addition, the Colon Solid Tumor Rules currently contains no Site Coding Section/Table. However, the Lung Solid Tumor Rules do and also refer one to the SEER/COC Manuals for document priority lists. The Urinary Solid Tumor Rules has both the Primary Site Codes Table and an additional section called Priority for Coding Primary Site, which does not reference a document priority list or other manuals. Unfortunately, there is additional information in Appendix C Bladder Coding Guidelines that may have been used in the past regarding site source priority.

Could the remaining applicable Appendix C information be consolidated into the Solid Tumor Rules consistently among all the sites to lessen the need for additional manual referencing? Also, is there a reason one site includes the Priority Site Coding instructions and others do not?

Autopsy/Pathology Report (2020) excerpts

External Examination

Nervous System: There is an 8.5 cm mass located in the right thoracic paraspinal area.

Final Anatomic Diagnosis

Clinical History: Paraspinal mass suspicious for neuroblastic tumor (detected by imaging studies)

Nervous System: Right thoracic paraspinal neuroblastoma, poorly differentiated

The case was reviewed by AFIP and called "extratesticular." Per our pathology consultant, the site should be coded to unknown because it is very doubtful that the tumor was primary in the soft tissue of the thigh. According to him, such tumors don't originate exclusively in the testes, but tend to occur along the central axis such as the mediastinum or retroperitoneum. If an extratesticular tumor arises in either of these areas, the primary site should be code to the mediastinum or the peritoneum rather than to unknown. Lesions primary in the testicle may also undergo maturation with fibrosis and involution. This process often leaves little evidence of the original tumor in the testis.

CT showed multiple masses in the liver and lymphadenopathy in areas of gastrohepatic ligament, celiac axis, superior mesenteric and left periaortic regions. No mention of a mass in pancreas or common duct. When the term "pancreatobiliary" primary is stated in the final diagnosis, what site code should be used?

I recently did a presentation on coding the data item Race. In my presentation I discussed understanding geography help code race in some circumstances. One of the slides demonstrates how large Polynesia is and what Pacific islands are found in Polynesia, such as, Tahiti, Samoa, and even Hawaii, all of which have their own codes. Someone in the audience asked "How do you code New Zealand? Upon some research, New Zealand is not listed in Appendix D of the SEER coding manual. We could code them 01-White. But research shows there is a very large indigenous population. Technically, New Zealand is located within the boundaries of Polynesia - Code 25 (Polynesian).

For example, if race is recorded as unknown on the facesheet of a hardcopy medical record or in the race field of an electronic medical record, how should race be coded for the following descriptions found in the history and physical or consultation reports submitted by clinicians?

1) Patient is Czechoslovakian

2) Patient is born in Czechoslovakia

3) Patient is Ethiopian

4) Patient is born in Ethiopia

5) Patient is Japanese

6) Patient is born in Japan

7) Patient is Brazilian

8) Patient is born in Brazil

Would you code these cases any differently if these descriptions were actually used in the race fields in the medical record or on a death certificate?