TN 7 (08-12)

DI 23022.810 Malignant Melanoma – with metastases

COMPASSIONATE ALLOWANCE INFORMATION

MALIGNANT MELANOMA

ALTERNATE NAMES

Cutaneous Melanoma; Metastatic Melanoma of the Skin; Malignant Melanoma

DESCRIPTION

Malignant Melanoma is a lethal form of skin cancer that may develop anywhere on a person’s body. It most often develops in areas that have had exposure to the sun, such as the back, neck, legs, arms, and face. However, it may occur in areas that do not receive much sun exposure, such as the soles of feet, palms of hands, and on fingernail beds. Malignant Melanoma with Metastases occurs when the malignant tumor spreads to other parts of the body.

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

Diagnostic testing: A treating source may detect melanoma simply by looking at a person’s skin. However, a definitive diagnosis of malignant melanoma is a biopsy. After diagnosis, CT scans, or other types of imaging may be done to determine if the cancer has spread to the lymph nodes or elsewhere in the body.

ICD-9: 172.0 - 172.9

ONSET AND PROGRESSION

The most dangerous aspect of malignant melanoma is its ability to spread (metastasize) to other parts of the body. Metastasis most often includes local or distant lymph nodes, brain, lungs, liver, and bone. The risk of developing malignant melanoma increases with age; however, it is also seen in young adults and children over 10 years of age. Survival rates are related to the stage of the melanoma. In its most advanced and lethal stage (Stage IV), melanoma has spread to the lymph nodes or organs, and is often incurable.

TREATMENT

Treatment for early-stage melanoma usually includes surgery to remove the melanoma. Surgery represents the only potentially curative modality; therefore, adequate excision is important to lessen the risk of a local recurrence. Even if a local recurrence after initial surgery can be successfully managed, individuals with this condition may die from subsequent metastatic disease. Treatment of recurrent malignant melanoma after initial treatment depends on the stage of the original melanoma, the prior treatment, and the site of recurrence, and may include chemotherapy, immunotherapy, or radiation.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for evaluation: The adjudicator needs medical evidence from treating sources and hospitals. The medical evidence should include clinical history and examination that describe the diagnostic features of the impairment, biopsy results, pathology reports, imaging testing, staging, pertinent treatment records, and up-to-date progress notes.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets Listing

13.03B2a,

13.03B2b, or 13.03B2c

Melanoma meets the listings if it has metastases to clinically apparent lymph nodes; to at least four lymph nodes that are not clinically apparent; or to adjacent skin or distant sites. There are no corresponding childhood listings.

Medical Equals

13.03B2

Melanoma with metastases in children may medically equal the listings for adults.

* Adjudicators may, at their discretion, use the Medical Evidence of Record or 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/0423022810
DI 23022.810 - Malignant Melanoma - with metastases - 08/10/2012
Batch run: 08/10/2012
Rev:08/10/2012