Melanoma Reporting

Measure Specification

Research and the publication of new guidelines in 2017 indicate newer tumor characteristics for more precise staging, with implications for treatment outcomes. In 2017, the American Joint Committee on Cancer (AJCC) Melanoma Expert Panel introduced several important changes to the Tumor, Nodes, Metastasis (TNM) classification. The relevant change for this measure in the eighth edition AJCC Cancer Staging Manual include: 1) tumor thickness measurements to be recorded to the nearest 0.

1 mm, not 0.01 mm; 2) definitions of T1a and T1b are revised (T1a, <0.8 mm without ulceration; T1b, 0.8-1.0 mm with or without ulceration or <0.8 mm with ulceration), with mitotic rate no longer a T category criterion. (Gershenwald et al.) The new guidelines state: “As supported by this univariate analysis and previous reports, the mitotic rate is likely an important prognostic determinant when evaluated using its dynamic range across melanomas of all tumor thickness categories.

Therefore, the AJCC Melanoma Expert Panel strongly recommends that mitotic rate be assessed and recorded for all primary melanomas, although it is not used for T1 staging in the eighth edition. The mitotic rate will likely be an important parameter for inclusion in the future development of prognostic models applicable to individual patients.” (http://onlinelibrary.

wiley.com/doi/10.3322/caac.21409/pdf ) The American Academy of Dermatology updated guidelines for management of primary cutaneous melanoma. In addition to re-affirming the importance of thickness, ulceration and mitotic rate (“There is strong evidence that at least 3 histologic features of the primary tumor are dominant predictors of outcome: Breslow thickness, ulceration, and dermal mitotic rate”), these guidelines also emphasized the importance of other elements include peripheral and deep margin status, microsatellitosis and lymphovascular invasion (Swetter et al).

For margin status, the guidelines note that “An additional essential element of the pathology report is the status of the peripheral and deep margins (positive or negative) of the specimen. Presence or absence of tumor at the surgical margin indicates whether the entire lesion was available for histologic evaluation and provides guidance for further management.

” Microsatellites, or tumors nests in the vicinity of the main invasive tumor, are an important component of the eighth edition of the AJCC staging system and per the AAD guideline “the presence or absence of microscopic satellites must be reported for accurate staging.

There is strong evidence that at least 3 histologic features of the primary tumor are dominant predictors of outcome: Breslow thickness, ulceration, and dermal mitotic rate. An additional essential element of the pathology report is the status of the peripheral and deep margins (positive or negative) of the specimen. Depending on the specific T- and N-category criteria, such patients would be staged as either stage IIIC or IIID.

Therefore, the presence or absence of microscopic satellites must be reported for accurate staging.

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For purposes of MIPS implementation, this procedure measure is submitted each time a procedure is performed during the performance period. Only one quality data code (QDC) per date of service for a patient is required. In instances where multiple specimens from different/unique lesions are submitted and resulted in a single report, each eligible specimen must be Met in order for the case to be considered Met (Denominator Exclusions and Denominator Exceptions are not considered eligible specimens).

If any eligible specimen is Not Met, the quality data code for Not Met should be submitted for this report.