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Report Produced: 01/28/2023 02:15 AM

Report Question ID Question Discussion (Ascending) Answer
20081045 MP/H Rules--Melanoma: How is histology coded for a regressing melanoma? See Discussion.

How is histology to be coded for the following tumors?

Example 1: Path showed malignant melanoma Histologic type: superficial spreading. Regression: present.

Example 2: Shave, mid back: malignant melanoma, lentigo melanoma type, level II, regression: present and prominent.

For cases diagnosed 2007-2014:

Apply MP/H Melanoma Histology Coding rule H5 and code the histologic type of the melanoma.

Code example 1 as 8743 [Superficial spreading melanoma].

Code example 2 as 8742 [Lentigo maligna melanoma].

20220014

Surgery of Primary Site--Melanoma: How is Surgery of Primary Site coded when a path specimen is labeled as a “staged excision” for a cutaneous melanoma. See Discussion.

Patient was diagnosed on biopsy with lentigo maligna melanoma of the nasal dorsum. The only available documentation of the subsequent surgery is a single pathology report with the nasal dorsum “staged excision (debulking specimen)” and four additional “staged excision” specimens of the same site.

Is it safe to assume this is a Mohs surgery? Would it be safe to assume staged excisions of sites other than skin of face, are also Mohs surgery?

Interpret a "staged excision" for cutaneous melanoma as a type of Mohs surgery.

Skin surgery codes are currently under review and revision.  Document details in available text fields.

20210009

Solid Tumor Rules (2018, 2021)/Histology--Melanoma: In what situation will Rule H4 be used to code the histology to regressing melanoma? See Discussion.

Rule H4 states: Code 8723/3 (malignant melanoma, regressing) when the diagnosis is regressing melanoma. However, if the diagnosis was strictly regressing melanoma or malignant melanoma, regressing, the first rule that applies is Rule H1 because regressing melanoma is a single, specific histologic type and Rule H1 states: Code the histology when only one histologic type is identified. Following the current rules, one would never arrive at Rule H4. Should the H Rules be reordered? Or should an example of when one would use Rule H4 be added to clarify when to use this rule?

Coding regressing melanoma has been an issue as registrars may not realize it is a reportable histology. Hence, H4 was written to reinforce correct histology. A note will be added to H1 instructing registrars to continue thru rules when the diagnosis is regressing melanoma.

20210008

Solid Tumor Rules (2018, 2021)/Histology--Melanoma: In what situation will Rule H6 be used to code the histology to lentigo maligna melanoma? See Discussion.

Rule H6 states: Code 8742/3 (Lentigo maligna melanoma) when the diagnosis is lentigo maligna melanoma with no other histologic types. However, if the diagnosis was strictly lentigo maligna or lentigo maligna melanoma, the first rule that applies is Rule H1 because lentigo maligna melanoma is a single, specific histologic type and Rule H1 states, Code the histology when only one histologic type is identified. Following the current rules, one would never arrive at Rule H6. Should the H Rules be reordered? Or should an example of when one would use Rule H6 be added to clarify when to use this rule?

Solid Tumor rule H6 is the same as MP/H rule H8. We found registrars have problems understanding reportable terminology and the corresponding ICD-O-3 histology code for lentigo maligna melanoma. It is included in H6 to capture cases where the registrar may not stop at H1. We will add another note to H1 instructing users to continue through the rules if the diagnosis is lentigo maligna melanoma.

20210059

Solid Tumor Rules (2018, 2021)/Histology--Melanoma: How is histology coded for an invasive melanoma with multiple subtype/variants? See Discussion.

Rule H8 of the Melanoma Solid Tumor Rules states that multiple variants of melanoma in one tumor are rare and a question must be submitted to Ask a SEER Registrar (AASR) for the correct histology code. However, our facility has seen a number of these cases in 2021 and would like to track the official answer and make it available to all in this format.

How should histology be coded for the following?

1. January 2021 diagnosis of left shoulder invasive malignant melanoma, histologic type: nodular and desmoplastic types per College of American Pathologists (CAP) summary of punch biopsy.

2. May 2021 shave biopsy of left arm invasive malignant melanoma, superficial spreading and nodular variant is listed in the CAP summary.

3. June 2021 diagnosis of right cheek invasive malignant melanoma, histologic subtype: superficial spreading and nodular seen on CAP summary of shave biopsy.

According to our dermopathology expert, code the histology to nodular melanoma 8721/3. There are numerous possible combinations of melanomas and the correct code depends on the types/variants present. We are currently working on a "Combined/Mixed Histology Code" Table for melanoma; however, it will likely not inlcude all possible combinations so continue submitting your questions to Ask A SEER Registrar. 

20071040 MP/H Rules/Multiple Primaries--Melanoma: Is there a difference between multiple primary rules M6 and M7 because both rules state that tumors occurring more than 60 days apart are to be reported as multiple primaries? See Discussion.

Rule M6 clearly states that an invasive melanoma occurring more than 60 days after an in situ melanoma is a multiple primary. However M7 states that any melanomas diagnosed more than 60 days apart are multiple primaries. Since M7 does not state malignant melanomas diagnosed more than 60 days apart, this implies that any scenario:

in situ following an invasive,

invasive following an in situ,

in situ following an in situ,

or invasive following an invasive

are all multiple primaries if more than 60 days apart. If that is the intent of M7, then M6 is totally unnecessary. If the intent of M7 is only for an invasive following an invasive, then the word malignant needs to be inserted as the first word of rule M7.

For cases diagnosed 2007 or later, M7 is intended to apply to in situ and invasive melanomas. Therefore, M6 and M7 are repetitive.

This will be corrected when revisions are made to the MP/H rules. In the meantime, both M6 and M7 result in multiple primaries so it does not matter which rule is used.

20061086 Reportability--Melanoma: Is an excisional biopsy of the skin with a diagnosis on the pathology report of "Tumoral melanosis" reportable by itself or must there be a pathologist note, such as "Note: Unless proven otherwise, tumoral melanosis should be considered as a regressed melanoma", in order for it to be considered reportable? See Discussion.

Skin, left upper back, exc Bx: Tumoral melanosis. Note: Unless proven otherwise, tumoral melanosis should be considered as a regressed melanoma.

If reportable, do we report a diagnosis of tumoral melanosis without a similar note?

Tumoral melanosis (TM) alone is not reportable. It is not listed in ICD-O-3. TM can be associated with a regressed melanoma, but it can also occur with other cutaneous tumors. The case is reportable if there is a diagnosis of melanoma.
20061087

Reportability--Melanoma: Is the following reportable? See Discussion.

PATH: Skin, Lt back exc bx: compound nevus with severe cytoarchitectural atypia and regression. Comment: due to overlap of morphology between MM and nevi with severe atypia, and since there's evidence of regression, consideration for re-excision may be considered if clinically indicated. The final diagnosis, compound nevus with severe atypia, is not reportable. This diagnosis is not listed in ICD-O-3.
20081044 MP/H Rules/Behavior--Melanoma of Skin: How are histology and behavior coded for a "malignant melanoma in situ with regression"? See Discussion. Per the microscopic portion of the path report, there is a zone of regression within the confines of the lesion, such that the possibility of antecedent invasive disease at the site cannot be ruled out with certainty.

For cases diagnosed 2007 or later:

Code malignant melanoma in situ with regression to 8720/2 [Melanoma in situ].

Code the histology according to the histologic type specified in the pathology report final diagnosis. Code the behavior as specified in the pathology report. Regression does not affect the coding of histology or behavior. See Melanoma Histology Coding rule H5. See 2007 SEER manual instructions for coding behavior, page 84.