Report Produced: 01/28/2023 02:48 AM
|Report||Question ID||Question (Ascending)||Discussion||Answer|
|20051103||CS Extension/Histology (Pre-2007)--Melanoma: When do the terms "regression is present," "apparent regression," or "undergoing regression" affect the coding of melanoma cases? See Discussion.||
For melanoma, many path reports document the presence or absence of regression. At what point does the presence of regression become significant enough to code it for histology and for CS Extension?
Example 1: Skin biopsy showed malignant melanoma, Breslow thickness 0.38 mm, Clark's level II, ulceration is absent, regression is present.
Example 2: Punch biopsy showed malignant melanoma, Clark's level II, 0.34-mm maximum depth of invasion, with apparent regression.
Example 3: Skin biopsy showed lentigo maligna undergoing regression.
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.
For tumors diagnosed prior to 2007:
Regression does not affect CS staging for cutaneous melanoma. "Malignant melanoma, regressing"  is coded only when it is the final diagnosis. Do not use code 8723 for the examples above.
According to our pathologist consultant:
Melanoma can occasionally undergo "spontaneous" regression -- the tumor can become smaller, and in some cases even disappear. This phenomenon is likely due to an increased immune response on the part of the "host" (person with the melanoma). This is noted occasionally in patients with metastatic disease which gets smaller, or even disappears. We think this is also what has happened in patients who get diagnosed with metastatic melanoma, say in a lymph node, but have no primary tumor, though sometimes give a history of a skin lesion which came and then went away, or a skin lesion which was not submitted for pathological examination. In addition, we (pathologists) occasionally see biopsies which have melanoma as well as the presence of the immune reaction to it, and once in a while, the immune reaction with little or no evidence of residual melanoma.
The College of American Pathologists says that regression of 75% or more of the melanoma carries an adverse prognosis.
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.
|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].
|20081055||MP/H Rules--Melanoma: How many primaries are represented if subsequent to a diagnosis of malignant melanoma of skin of left thorax in April 2006, a metastatic melanoma is discovered in the soft tissue of the abdomen and in the skin and subcutaneous tissue of the groin in late 2007? See Discussion.||
4/20/06: skin left lateral thorax, excision: Pedunculated malignant melanoma, 0.5 CM in height, Clark's level 3, Breslow depth 0.5 CM, superficial ulceration noted. No host response. Margins clear.
6/19/06: Four sentinel LNs negative. Interferon therapy.
10/30/07: FNA of soft tissue, left lower abdomen: consistent with metastatic melanoma.
12/20/07 A) sentinel lymph node, left groin, biopsy: No morphologic or immunophenotypic findings support for metastatic melanoma (see comment). B) skin and subcutaneous tissue, left groin, excisional biopsy: Metastatic malignant melanoma (see comment). Lymphovascular invasion identified. Margins free of melanoma. Melanoma 1.5 MM from the closest designated deep margin and 5 MM from the designated 6:00 margin. C) skin, left groin/additional inferior margin, excisional biopsy: No significant histopathologic abnormality. No evidence of villus or melanoma or malignancy. Comment: A 0.8 cm metastatic nodular melanoma is present in the adipose tissue. The underlying skin is unremarkable. There is no evidence of ulceration, melanocytic lesion, melanoma in situ, or regression of melanoma. Block A1 is sent for immunohistochemical studies. The immunophenotypic findings provide no support for metastatic melanoma in lymph node. Please see the immunohistochemical study. The primary MD states "Recurrent intransit mets, left groin."
|For cases diagnosed 2007 or later, this is a single primary, melanoma of the thorax 4/20/06. The subsequent reports mention metastases, but do not document another primary. Do not count metastatic lesions as new primaries.|
|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.
|20100007||MP/H Rules/Histology--Melanoma: Regarding SINQ #20081044, when would you apply Rule H6 rather than Rule H5 for a cutaneous malignant melanoma given that you normally always have a specific cell type mentioned?||For cases diagnosed 2007 or later, Rule H6 is used when you do not have a specific cell type other than regressing melanoma, or malignant melanoma, regressing. If you have regressing melanoma with a specific cell type, apply rule H5.|
|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.|
|20061051||Reportability--Melanoma: Is the final diagnosis for an excisional skin biopsy of "compound nevus with severe cytoarchitectural atypia and regression" considered reportable if a re-excision may be clinically indicated because there is an "overlap of morphology between malignant melanoma and nevi with severe atypia, and there's evidence of regression"?||Compound nevus with severe atypia is not reportable unless also stated to be malignant melanoma or melanoma in situ.|
|20051078||Surgery of Primary Site--Melanoma: If the surgical margins are greater than 1 cm for length and width but less than 1 cm for depth, do we code surgery in the 30-33 range?||Yes, assign a surgery code from the 30-33 range when any margin is less than 1 cm. Since tumor thickness is an important prognostic factor for cutaneous melanoma, the deep margin is of particular importance.|