# Presentation: 186316

## Cutaneous Melanoma

## Equivalent Terms, Definitions and Illustrations

- Skin only C440-C449
- Definitions identify reportable tumors
- Evolving melanoma – not reportable

**Notes:**
Use these rules only for melanomas originating in the skin.

The definitions contain information about reportability for a number of terms that are difficult to interpret.

## Equivalent Terms, Definitions and Illustrations

- Familial Atypical Multiple Mole Melanoma Syndrome (FAMM or FAM-M)
- Melanoma in family members
- Family with multiple moles

**Notes:**
Persons with FAMM may have multiple melanomas in their lifetime.

## Regressing Melanoma

-  Not a histology
- Has ICD-O-3 code
- Prognostically significant
- Thinner
- Staging difficult

**Notes:**
The MP/H Task Force chose not to collect regressing melanoma in the data field “Histology.” Although it is an important piece of information, it is information that affects staging and prognosis, not the histology. The Task Force will forward the information they collected to the Collaborative Staging Steering Committee for their consideration; the MP/H Task Force feels the information would more correctly be collected in a CS Site Specific Factor.

## Equivalent Terms, Definitions and Illustrations

- Skin layers
- Epidermis
- Dermis
- Hypodermis/subcutis/subcutaneous fat

**Notes:**
The skin layers are defined in the Equivalent Terms and Definitions. Use this description for Rule H4

## Multiple Primary Rules

**Notes:**
Rules used to determine whether the patient has single or multiple primaries.

## Unknown if Single or Multiple Melanomas 

**Notes:**
Use this module when:

Central registry gets a pathology report of a biopsy followed by a hospital report of a resection. Central registry is not sure if there was a single melanoma or multiple melanomas

Hospital registry has an H&P documenting a biopsy in the physician’s office. Patient has another biopsy or resection. Registrar cannot confirm whether the patient had a single melanoma or multiple melanomas.

## M1

- When it is not possible to determine if there is a **single** melanoma **or multiple** melanomas, opt for a single melanoma and abstract as a single** **primary.
***Note: ***Use this rule only after all information sources have been exhausted.

**Notes:**
This is a default so everyone will handle the cases in a standardized manner. 

The note is a warning not to default to a single melanoma until all sources of information have been exhausted.

## Single Melanoma

## M2

- A **single melanoma** is always a single primary.

**Notes:**
A single melanoma is always a single primary

## Multiple Melanomas

## M3

- Melanomas in sites with ICD-O-3 **topography** codes that are **different** at the second (C_**x**_xx), third (Cx_**x**_x) or fourth (C44_**x**_) character are multiple primaries.

**Notes:**
Melanomas in different subsites of the skin are multiple primaries.

A  melanoma of the skin and a separate tumor in any other site are multiple primaries.

## M4

- Melanomas with **different laterality** are multiple primaries.
***Note:***  A **midline** melanoma is a different laterality than right or left.

**Notes:**
Lateralities are:
Right
Left
Midline

One issue with determining melanoma primaries using ICD-O topography codes is that the topography codes for skin divide the body into large areas. 
The other problem in melanoma is laterality and inconsistency --  Some count two melanomas if there is one on the right & one on the left chest while others count those as one. To address this, the rules say melanomas w/different literalities are multiple primaries. 
Unknown laterality is not included in this rule. If the laterality is unknown, default to a single primary.

## M4 Examples

***Example 1:***  Melanoma of the right side of the chest and a melanoma at midline of the chest are different laterality, multiple primaries.

**Notes:**
Midline and right are different lateralities.
Trunk is problematic in melanoma coding. Due to concern about the possible impact on incidence counts, the task force decided to use laterality and the multiplicity counter for now to capture these multiple melanomas. 

## M4 Examples

***Example 2:***  A melanoma of the right side of the chest and a melanoma of the left side of the chest are multiple primaries.

**Notes:**
Right and left are different primaries.

## M5

- Melanomas with ICD-O-3 **histology** codes that are **different** at the first (_**x**_xxx), second (x_**x**_xx) or third number (xx**x**x) are multiple primaries.

**Notes:**
Same as previous ICD-O-3 histology rule.

## M6

- An **invasive** melanoma that occurs **more than 60 days after** an **in situ** melanoma is a multiple primary.

**Notes:**
First explain that if an invasive occurs less than 60 days after an in situ you would abstract as a single primary and code the invasive melanoma.

This is new for everyone except SEER registries. Explain the rule thoroughly.

## M6 Notes

***Note 1:*** The purpose of this rule is to ensure that the case is counted as an incident (invasive) case when incidence data are analyzed.

**Notes:**
Note one means that the incidence counts are for invasive cases only with a few exceptions. 

Explain that we do not want survival graphs showing people dying of in situ disease. We also don’t want the survival time affected by the time between an in situ and an invasive melanoma

## M6 Notes

***Note 2:*** Abstract as multiple primaries even if the medical record/physician states it is recurrence or progression of disease.

**Notes:**
Note two: IMPORTANT. You may have to explain to your physicians the reason behind the rule. The CoC physicians were all supportive when the rule and rationale were presented to them. 

## M7

- Melanomas diagnosed **more than 60 days** apart are multiple primaries.

**Notes:**
No change from previous rule – Using 60 days instead of 2 months for more consistent interpretation.

## M8

- Melanomas that **do not meet any** of the above **criteria** are abstracted as a single primary.

**Notes:**
This is a default rule. We do not have to write multiple rules saying that these conditions are single primaries. If the case did not meet the criteria for any of the previous rules, it is a single primary.

## M8 Notes

***Note 1:*** Use the data item “Multiplicity Counter” to record the number of melanomas abstracted as a single primary.

**Notes:**
A melanoma, NOS on the right chest and another melanoma, NOS on the right groin within 60 days would be coded as a single primary since the site codes are the same “skin of trunk.”   We will, however, be able to collect the information that there were two melanomas in the data item “Multiplicity Counter.”

## M8 Notes

***Note 2: ***When an invasive melanoma follows an in situ melanoma within 60 days, abstract as a single primary.
***Note 3:*** All cases covered by this rule are the same site and histology.

**Notes:**
Using a default code is new for most people. Notes 1 and 2 are intended to reassure the abstractor that they should default to a single primary.

## M8 Examples

- This is NOT intended to be an exhaustive set of examples; there are other cases that may be classified as a single primary.  ***Warning:  Using only these case examples to determine the number of primaries can result in major errors.***

**Notes:**
Emphasize that these examples do not cover all cases that would be abstracted as a single primary.

## M8 Examples

| Example 1:  Solitary melanoma on the left back and another solitary melanoma on the left chest | Example 2:  Solitary melanoma on the right thigh and another solitary melanoma on the right ankle  |
| --- | --- |

## Histology Coding Rules

## Single Melanoma or Multiple Melanomas Abstracted as a Single Primary

**Notes:**
For this site only, the histology rules are the same for a single melanoma and for multiple melanomas abstracted as a single primary – only one module for melanoma histology coding rules.

## H1

- Code the histology documented by the physician when there is **no pathology/cytology specimen **or the **pathology/cytology** report is **not available**.

**Notes:**
Used when there was no pathology or cytology specimen and when the abstractor does not have access to the pathology or cytology report.

## H1 Notes

***Note 1:  ***Priority for using documents to code the histology
- Documentation in the medical record that refers to pathologic or cytologic findings
- Physician’s reference to type of melanoma in the medical record
- PET scan

**Notes:**
Gives a priority for coding histology.

--If the medical record references a pathology or cytology report. Example: Patient had a biopsy prior to arrival that was positive for nodular melanoma
--Use the physician’s documentation in the medical record giving the histology. Example: H&P with a diagnosis of nodular melanoma, skin of right arm.
--Reference to histologic type in PET scan

## H1 Notes

***Note 2:***  Code the specific histology when documented.

**Notes:**
If the histology is documented as nodular (for example), code nodular.

## H2

- Code the histology from the metastatic site when there is **no pathology/cytology specimen** **from the** **primary site**.
***Note:***  Code the behavior /3

**Notes:**
If there is no pathology or cytology specimen from the primary site, code the histology from a biopsy of a metastatic site. Example: Patient has biopsy of supraclavicular node that was positive for metastatic malignant melanoma.  No primary tumor is identified. Code the histology as malignant melanoma.

## H3

- Code the histology when only **one histologic type** is identified.

**Notes:**
Used when diagnosis is simply melanoma or superficial spreading melanoma, for example.

## H4

- Code the invasive histologic type when there are **invasive and in situ** components.

**Notes:**
This is a change from the previous rules. Be sure to emphasize.

The invasive histology is the one that will affect survival and govern treatment. By coding the invasive type, the case will be placed in the correct analysis group.

Even if the in situ portion is more specific, it will not be the histology that impacts survival and treatment

## H5

- Code the histologic type when the diagnosis is regressing melanoma and a histologic type.
***Example:*** Nodular melanoma with features of regression.  Code 8721 (Nodular melanoma).

**Notes:**
Code the specific histology if documented.

## H6

- Code 8723 (Malignant melanoma, regressing) when the diagnosis is regressing melanoma.
***Example****: *Malignant melanoma with features of regression.  Code 8723.

**Notes:**
If the diagnosis is malignant melanoma, NOS with regression, code regressing melanoma.

## H7

- Code the **histologic type** when the diagnosis is **lentigo maligna** melanoma **and** a **histologic** type.

## H8

- Code 8742 (Lentigo maligna melanoma) when the diagnosis is **lentigo maligna** melanoma

## H9

**Code the** most **specific **histologic **term** when the diagnosis is melanoma, NOS (8720) with a single specifc type.

**Notes:**
This is the same as the previous NOS rule

## H9 Notes

***Note 1: ***The specific type for **in situ** lesions may be identified as pattern, architecture, type, subtype, predominantly, with features of, major, or with ____differentiation

**Notes:**
Note that pattern and architecture are used for in situ lesions only

## H9 Notes

***Note 2: ***The specific type for **invasive **lesions may be identified as type, subtype, predominantly, with features of, major, or with ____differentiation

**Notes:**
Example:  Malignant melanoma, nodular type.

## H10

- Code the histology with the **numerically higher **ICD-O-3 code.

**Notes:**
This is a default rule for any cases did not meet the criteria of the first 9 rules

## MP/H Task Force