TN 19 (12-18)

DI 23022.460 Mucosal Malignant Melanoma

COMPASSIONATE ALLOWANCE INFORMATION

MUCOSAL MALIGNANT MELANOMA

ALTERNATE NAMES

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

DESCRIPTION

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.

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING

 

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:

  • X-rays;

  • CT scan;

  • MRI;

  • PET scan; or

  • Other imaging studies.

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

TREATMENT

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.

PROGRESSION

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.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:

  • Clinical history and examination that describes the diagnostic features of the impairment;

  • Pathology report; and

  • Documentation of mucosal melanoma metastasis.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets

13.29 C

Mucosal melanoma meets the criteria in listing 13.29 C.

113.29 C

Mucosal melanoma meets the criteria in listing 113.29 C.

Equals

 

* 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.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423022460
DI 23022.460 - Mucosal Malignant Melanoma - 12/03/2018
Batch run: 12/03/2018
Rev:12/03/2018