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Abstracting Keys

Examination of entire tumor is essential to accurate staging: wedge, punch and shave biopsies are inadequate for staging purposes.

Look for thickness, Clark's level, ulceration and information regarding nodal metastases in the operative and pathology reports.

When abstracting EOD Tumor size, tumor thickness or depth of invasion is recorded instead of tumor size. Record the actual measured thickness in millimeters from the pathology report.

When abstracting EOD Extension, if there is a discrepancy between the reported tumor thickness or depth and the Clark's level, use the higher, more extensive code.

For primary sites of C44.3 and C44.5, if the tumor is midline, code laterality as '9' for midline.

AJCC Staging 5th Edition:

In case of discrepancy between the T category that would be assigned by Breslow and Clark methods, record the higher value for the pT category.

If the extent of the primary lesion can't be accurately assessed due to prior surgery or surgery or specimen processing-related distortion, code the tumor as TX.

If no primary site can be found due to spontaneous regression, code the tumor as T0.

Satellite lesions and subcutaneous nodules within 2 cm of the primary tumor are considered extensions and should be coded as pT4b.

Satellite lesions, cutaneous/subcutaneous metastases more than 2 cm away from the primary tumor but within the pathway to the regional lymph nodes are coded as N2b, "in-transit metastases".

AJCC Staging 6th Edition:

The main difference between clinical and pathologic staging is how the lymph nodes are staged; by clinical/radiologic examination, or by pathologic examination.

If a melanoma cannot be microstaged, code the tumor as TX.

The T category thresholds of melanoma thickness are defined in whole integers; 1.0, 2.0 and 4.0.

Ulceration is defined by the absence of an intact epidermis (upon pathologic examination).

Clark's level is not used to define the T subcategories for thicker melanomas (T2, T3 and T4).

The number of lymph node metastases identified by the pathologist is required for staging.

When metastasis is involved, record information regarding elevated serum LDH levels.