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Refused [code 7] means this modality was specifically recommended by the physician and the patient refused. If two treatment alternatives were offered and surgery was refused, code Reason no surgery of primary site 1 [Surgery of the primary site was not performed because it was not part of the planned first-course treatment].

Refusal of surgery does not necessarily mean that all treatment was refused. Coding Surgery of Primary Site as "refused" does not affect the coding of Radiation, Chemotherapy, Hormone Therapy, etc.

For tumors diagnosed prior to 2007:

Please see SEER Inquiry question ID number 20041104.

For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

Code Radiation (Rx Summ--Radiation) to 0 [None; diagnosed at autopsy].

SEER does not collect the Reason For No Radiation field. However, those who abstract using software that captures this data item can identify these cases. Code 5 [radiation not administered because patient died] reflects this situation.

Radiation (Rx Summ-Radiation) is a SEER field. This field is derived from the data collected in Rad-Boost Rx Modality and Rad-Regional TX Modality. These fields do not include a choice for "radiation not given because the patient died prior to treatment." Therefore, this information cannot be coded in the Radiation field.

This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Record the larger tumor size and the farthest extension documented.

Code CS Tumor Size/Extension Evaluation to 6 [Surgical resection performed, WITH pre-surgical systemic treatment...; tumor size/extension based on pathologic evidence].

Code CS Tumor Size for the example to 045 [4.5 cm].

Code CS Extension to 20 [Local skin involvement ...] based on clinical description provided.

For tumors diagnosed prior to 2007:

Code the Histology field to 8771/3 [epithelioid cell melanoma]. The "growth phase" information in this case describes the horizontal spread and the "invasive" or vertical growth through the layers of skin.

For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

For cases diagnosed 1998-2003:

Use the combination of clinical and pathologic information to code EOD for primary site, extension and lymph nodes. Code the more extensive disease. If lymph nodes are positive clinically and not positive after neoadjuvant treatment, code lymph node involvement. If lymph nodes are negative clinically and positive on path, code lymph node involvement. When neoadjuvant treatment is administered because of a clinical statement of stage or involvement, code EOD based on this clinical information, even if later pathologic information would lead to a lesser EOD. General guideline number 6 (page 1 of SEER EOD-88 3rd ed.) points out that clinical information must be considered when coding EOD. However, do not code EOD based on clinical information disproved by pathologic findings in the absence of intervening treatment. The scenario above: The clinical involvement of the nodes justifies the neoadjuvant chemotherapy. Therefore, code EOD based on the clinical lymph node involvement.