Program Operations Manual System (POMS)
TN 32 (08-20)
DI 23022.460 Mucosal Malignant Melanoma
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COMPASSIONATE ALLOWANCES INFORMATION
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MUCOSAL MALIGNANT MELANOMA
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ALTERNATE NAMES
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Primary Mucosal Melanomas; Extracutaneous Malignant Melanomas (EMM); Primary Sinonasal
Mucosal Melanoma (SNMM); Anorectal Melanoma (ARM); Mucosal Melanoma of the Head and
Neck; Melanoma of the Esophagus; Melanoma of the Male Genito-Urinary Tract; Vulval
Melanoma; Vaginal Melanoma; Mucosal Melanoma; Buccal Melanoma; Oral Melanoma
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DESCRIPTION
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Malignant Mucosal Melanomas are rare cancers, representing <1% of all melanomas. They are distinguished from
cutaneous (skin) melanomas in that they orginate in the mucus membranes lining the
respiratory, digestive, and genitourinary tracts or in the eyes as well as in the
cerebral meninges. The most common type of mucosal melanomas occurs in the head and
neck area.
Because they are not easily detected, they are often diagnosed very late in their
course and have poor prognosis for recovery using standard therapies. Five-year survival
data shows a rate of 10-15%. The disease occurs primarily in the elderly and affect
both genders equally.
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND
ICD-9-CM/ICD-10-CM
CODING
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Diagnostic testing: A biopsy of the pigmented lesion is performed and reviewed by a pathologist. Additionally,
lymph node biopsy of the regional nodes may be performed to determine staging.
Other supporting lab tests include:
Physical findings: The nasal cavity is the most common location of mucosal melanoma within the head
and neck area; and it may present with epistaxis, nasal obstruction, or facial pain.
Those lesions involving the oral cavity usually present as a painless mass with ulceration/bleeding.
Involvement of the genital/urinary tracts may present with abnormal discharge or bleeding/hematuria.
The rectal area may involve pain or a mass.
ICD-9: Coded according to site of malignant neoplasm
ICD-10: C43
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PROGRESSION
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This is a rare condition with a peak incidence in patients aged 60-80 years. Unlike
melanomas involving the skin, exposure to sunlight is not a risk factor. Prognosis
is poor and survival times vary with the location of the melanoma and stage of the
disease at the time of diagnosis.
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TREATMENT
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Treatment involves surgical resection and may include adjuvant radiation and chemotherapy.
As there is a high incidence of systemic disease in these cases, a CT/PET scan is
indicated prior to radical surgery. Metastatic disease is not curable.
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SUGGESTED PROGRAMMATIC ASSESSMENT*
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Suggested MER for Evaluation:
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Clinical history and examination that describes the diagnostic features of the impairment;
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Documentation of mucosal melanoma metastasis.
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Suggested Listings for Evaluation:
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DETERMINATION
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LISTING
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REMARKS
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Meets
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13.29 C
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Mucosal melanoma meets the criteria in listing 13.29 C. |
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113.29 C
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Mucosal melanoma meets the criteria in listing 113.29 C. |
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Equals
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| * Adjudicators may, at their discretion, use the Medical Evidence of Record or the
listings suggested to evaluate the claim. However, the decision to allow or deny the
claim rests with the adjudicator.
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