Melanoma: Tracking and Evaluation of Recurrence

Measure Specification

Melanoma recurrence is an outcome that needs precise evaluation. This measure will allow for the development of a system in which melanomas can accurately be tracked so that we can truly understand the effectiveness of care. The literature describes a lack of a standard for follow-up, tracking, and evaluating melanoma in early-stage disease. This measure will evaluate the frequency of recurrence along with the type of recurrence (local, in transit, LN, systemic) that occurs after an excisional procedure.

It is also recognized that there may be a lack of communication between the excising clinician and the clinician who is following the patient longitudinally. This measure is also an initiative to drive a care-collaborative network that encourages communication about the recurrence status of melanoma patients.

1. For common follow-up recommendations for all patients: “Follow up schedule is influenced by risk of recurrence and new primary melanoma, which depends on patient/family history of melanoma, mole count, and/or presence of atypical moles/dysplastic nevi.” (NCCN Melanoma: Cutaneous, 2025) 2. Patterns of Recurrence: “For patients who present with stage I-II melanoma and who are rendered free of disease after initial treatment, recurrences are distributed as follows: approximately 15% to 20% are local or in transit” (NCCN Melanoma: Cutaneous, 2025) 3.

Timing of recurrence: “Data from several studies suggest that the time it takes for the risk of recurrence to reach its low plateau depends on the stage of disease at first presentation. In a retrospective study of patients who initially presented with stage I melanoma (N = 1568), 80% of the 293 recurrences developed within the first 3 years, but some recurrences (<8%) were detected 5 to 10 years after the initial treatment.

A prospective study found that for patients with stage I or II at initial presentation, the risk of recurrence reached a low level by 4.

This measure contains two strata defined by two submission criteria. This measure produces two performance rates. There are 2 Submission Criteria for this measure: 1) All patients that the clinician has performed a type of excisional surgery for melanoma or melanoma in situ in the past 5 years with an initial AJCC staging of 0, I, or II. AND 2) Documentation by the clinician who performed the surgery that an exam for recurrence of melanoma was performed on the patient within the performance period.

This measure will be calculated with 2 performance rates: 1) Documentation by the clinician who performed the surgery that an exam for recurrence of melanoma was performed on the patient within the performance period. 2) All patients that were diagnosed with a recurrent melanoma in the current performance period. For accountability reporting in the CMS MIPS program, the rate for submission criteria 1 is used for performance.

For the purposes of MIPS implementation, this patient-process measure is submitted a minimum of once per patient for the performance period. The most advantageous quality data code will be used if the measure is submitted more than once. Performance rate 2 is an inverse measure which means a lower calculated performance rate for this measure indicates better clinical care or control.

The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures, a rate of 100% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control.