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Tumor Tip of the Week-Clarification on Melanoma Surgery

Scenario:  6/25/2018 Path report: Excisional SHAVE biopsy skin lesion left arm: Malignant melanoma, skin of back: 0.9mm thick, no ulceration, mitosis 2/mm2; negative margins (NO MEASUREMENT NOTED ON PATH REPORT, IT’S JUST STATED NEGATIVE)

8/15/2018 Op Report: Wide excision of melanoma, left forearm, with 1.5cm margin; left axilla sentinel lymph node was identified with two large hot lymph nodes

8/15/2018 Path Report. Wide excision, left arm: no residual melanoma, previous biopsy site skin of back. Left axillary SLN: 0/2 (NOTE: NO MEASUREMENT IS NOTED ON PATH REPORT, IT JUST STATES NO RESIDUAL MELANOMA)

Question:  How would the 8-15 Wide Excision be coded?

  • 31 Shave biopsy followed by a gross excision of the lesion
  • 46 Wide excision or re-excision of lesion or minor (local) amputation with margins more than 1 cm and less than or equal to 2 cm

Answer:  46 Wide excision or re-excision of lesion or minor (local) amputation with margins more than 1 cm and less than or equal to 2 cm

Rationale: Technical Advisory Group (TAG)-Clarification on Melanoma Surgery 

From: AskSEERCTR <askseerctr@imsweb.com
Sent: Wednesday, August 21, 2019 2:23 PM
Subject: RE: Ask SEER CTR #21342

This was discussed last week at a meeting of the Technical Advisory Group (TAG), an ad hoc group with representation from all of the standard setters. The consensus decision is: For assigning melanoma surgery codes, use the path report as the first priority. If info not available on path report, op report may be used when margins are specified. Exception is for code 47 where specific instructions about microscopic confirmation are included. Important: this does not apply to the margins data item, only to surgery codes.

I will add to this: do not compute margins from path or op report. Use margins when stated. If not stated, margins are unknown.

I have sent this information to the SEER*Educate leads.

Thank you,

The SEER Data Quality Team

 

  1. Review Path Report-margins are negative but not measured.
  2. Review Op note to assist when no residual tumor on pathology. Op margins were 1.5cm
  3. Thus appropriate Code would be 46 Wide excision or re-excision of lesion or minor (local) amputation with margins more than 1 cm and less than or equal to 2 cm
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