TN 21 (12-18)

DI 23022.810 Skin Malignant Melanoma with Metastases

 

COMPASSIONATE ALLOWANCE INFORMATION

SKIN MALIGNANT MELANOMA

ALTERNATE NAMES

Cutaneous Melanoma; Metastatic Melanoma of the Skin; Skin Malignant Melanoma; Malignant Melanoma

DESCRIPTION

Skin 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. Skin 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.

Physical findings: Individuals with skin malignant melanoma may present with:

• Unusual moles, sores, lumps, blemishes, markings, or changes on the skin;

• Sores that do not heal;

• Spread of pigment from the border of a spot into surrounding skin;

• Redness or a new swelling beyond the border of a mole;

• Changes in sensation on the skin, such as itchiness, tenderness, or pain; and

• Changes in the surface of the mole/skin such as itchiness or painful sensations, bleeding, scabs, crusty, inflammation, thickening of the skin, firm/raised center of a mole or spot on the skin, scaliness, oozing, bleeding, or the appearance of a lump or bump.

ICD-9: 172.0 - 172.9

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:

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

• Pathology and biopsy reports of the cancer; and

• CT scan, MRI scan, or ultrasound reports.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets

13.29 B 1

Skin malignant melanoma meets the criteria in listing 13.29 B 1 if it has metastases to clinically apparent lymph nodes; to at least four lymph nodes that are not clinically apparent; or to adjacent skin (for example, satellite lesions) or distant sites (for example, liver, lung, or brain).

13.29 B 2

Skin malignant melanoma meets the criteria in listing 13.29 B 2 if it has metastases to clinically apparent lymph nodes; to at least four lymph nodes that are not clinically apparent; or to adjacent skin (for example, satellite lesions) or distant sites (for example, liver, lung, or brain).

13.29 B 3

Skin malignant melanoma meets the criteria in listing 13.29 B 3 if it has metastases to clinically apparent lymph nodes; to at least four lymph nodes that are not clinically apparent; or to adjacent skin (for example, satellite lesions) or distant sites (for example, liver, lung, or brain).

113.29 B 1

Skin malignant melanoma meets the criteria in listing 113.29 B 1 if it has metastases to clinically apparent lymph nodes; to at least four lymph nodes that are not clinically apparent; or to adjacent skin (for example, satellite lesions) or distant sites (for example, liver, lung, or brain).
113.29 B 2 Skin malignant melanoma meets the criteria in listing 113.29 B 2 if it has metastases to clinically apparent lymph nodes; to at least four lymph nodes that are not clinically apparent; or to adjacent skin (for example, satellite lesions) or distant sites (for example, liver, lung, or brain).

113.29 B 3

Skin malignant melanoma meets the criteria in listing 113.29 B 3 if it has metastases to clinically apparent lymph nodes; to at least four lymph nodes that are not clinically apparent; or to adjacent skin (for example, satellite lesions) or distant sites (for example, liver, lung, or brain).

Equals

13.29 B

Cutaneous melanoma with a tumor thickness greater than 4 mm, up to 8 mm, medically equals 13.29 B if ulceration is present and the mitotic rate is equal to or greater than 5 mitoses/mm2. Cutaneous melanoma with a tumor thickness greater than 8 mm and a mitotic rate equal to or greater than 5 mitoses/mm2 medically equals 13.29 B, even if ulceration is not present.

113.29 B

Cutaneous melanoma with a tumor thickness greater than 4 mm, up to 8 mm, medically equals 113.29 B if ulceration is present and the mitotic rate is equal to or greater than 5 mitoses/mm2. Cutaneous melanoma with a tumor thickness greater than 8 mm and a mitotic rate equal to or greater than 5 mitoses/mm2 medically equals 113.29 B, even if ulceration is not present.
* 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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http://policy.ssa.gov/poms.nsf/lnx/0423022810
DI 23022.810 - Skin Malignant Melanoma with Metastases - 12/28/2018
Batch run: 12/28/2018
Rev:12/28/2018