08-01-2025
Scenario: 2025 case
- 8-1-2025 Patient presents with a 1.5 cm black nodule on the right lateral thigh
- 8-10-2025 Shave biopsy done at reporting facility) + malignant melanoma right anterior lateral distal thigh, greater than 1.8 mm in Breslow thickness, no ulceration, 1 mitotic figure per mm2 Note: Lesion classified at least Clark’s level IV as the reticular dermis is involved, lesion extends to margin
- 8-15-2025Wide Excision done at an outside facility:
- Op Note:
- Operation: Wide local excision melanoma right distal thigh, specimen diameter 4.2, length 12cm, Sentinel Lymph Node Procedure
- Operative procedure: The previous biopsy site was delineated w/ a marking pen, creating a 1cm circumferential margin. There was a large residual flat pigmented area.
- Path Report:
- Skin right thigh, wide local excision, negative for residual melanoma, margins negative, 1 sentinel lymph node negative
- Op Note:
Question: How would you code Tumor Size Summary?
- 015 {size from clinical exam}
- 001 {1.8mm thickness from shave biopsy}
- 002 {2mm-round 1.8mm thickness of tumor from shave biopsy)
- 042 {4.2cm specimen diameter noted on op note from Wide local excision}
- 120 {12.0 specimen length noted on op note from Wide local excision}
- 999 {size not mentioned on the Shave biopsy or Wide Excision path report}
Answer: 015 {size from clinical exam}
SEER/STORE
* Tumor size is the diameter of the tumor, not the depth or thickness of the tumor, thus cannot use the Breslow thickness
*Size of the tumor is not on the Shave or Wide excision path report. The specimen size is not the size of the tumor but the size of the whole amount of tissue excised. So, we will utilize the size noted on physical exam 1.5cm
Other Fields to Consider
| Field | Code | Rationale |
| EOD Primary Tumor | 300 Reticular dermis invaded Clark level IV | Per Path Report Note: Lesion classified at least Clark’s level IV as the reticular dermis is involved |
| Breslow Tumor Thickness | XX.9 | Per Path report notes greater than 1.8mm Breslow thickness. See Note 5 in SSDI Manual Note 5: If the pathologist describes the thickness as “at least,” use the appropriate A code. An exact measurement takes precedence over A codes. If the pathologist states “greater than” instead of “at least”, code to XX.9, unless it is greater than 9.9 mm (Code AX.0) Examples: Pathologist states the thickness is “at least 2.0 mm.” Code A2.0 Pathologist states the thickness is “greater than 4 mm.” Code XX.9 |
| Clinical Margin Width | 1.0 | Per Wide excision Op note: The previous biopsy site was delineated w/ a marking pen, creating a 1cm circumferential margin Per SSDI Manual Note 3: Code the peripheral surgical margins from the operative report from a wide excision Do not use the pathology report to code this data item. Margins from wide excision-Measured from the edge of the lesion or the prior excision scar to the peripheral margin of the specimen, do not use deep margin Do not add margins together |
| RX Hosp Surg-2023 | B230 Shave Biopsy | Most definitive surgery done at reporting facility was a shave biopsy |
| RX Summ Surg-2023 | B530 Shave Biopsy followed by wide Excision | Most definitive surgery done anywhere was the Wide excision after the shave biopsy |
| Class of Case | 13 | Diagnosed at reporting facility & some treatment (shave bx) done at my facility, some treatment done elsewhere (wide excision) |
