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Malignant Melanoma of the Skin B026

Last amended 
4 April 2016

Current RMA Instruments:

Reasonable Hypothesis SOP
102 of 2015
Balance of Probabilities SOP
103 of 2015
Changes from Previous Instruments:

SOP Bulletin 185

ICD coding:
  • ICD-9-CM: 172
  • ICD-10-AM: C43
Brief description:

This is a primary malignant neoplasm of the pigment cells (melanocytes) of the skin.  It does not include other primary melanomas in other body tissues.

Confirming the diagnosis:

To confirm the diagnosis there needs to be evidence on histology of the neoplasm.

The relevant medical specialist is a dermatologist or oncologist.

Additional diagnoses covered by these SOPs
  • Malignant melanoma of the skin

  • Hutchinson melanotic freckle of the skin

  • Melanoma in situ of the skin

  • Lentigo maligna of the skin

  • Melanoma of the skin of the lips but not the oral mucosa.

  • Melanoma of the perianal skin region but not the anal mucosa.

  • Melanoma of the genital skin

Conditions not covered by these SOPs 
  • Ocular melanoma* - Malignant neoplasm of the eye

  • Oral mucosa melanoma* - ‘Malignant neoplasm of the oral cavity, oropharynx and hypopharynx’.

  • Anal mucosa melanoma# - Note this is excluded from the SOP for ‘Malignant neoplasm of the anus and anal canal’.

  • Melanoma of the paranasal sinuses

  • Melanoma of the tarsal conjunctiva

* another SOP applies  - the SOP has the same name unless otherwise specified

# non-SOP condition

Clinical onset

A melanoma is normally asymptomatic and so the clinical onset is generally the date of first diagnosis.   For a melanoma arising in a mole the date of clinical onset may be when a change in the mole was first noticed, such as a change in size or colour, or bleeding.

Clinical worsening

For an aggravation to be relevant, there must be a clinical worsening out of keeping with the natural history of the underlying pathology and it is difficult to ascertain whether a malignant melanoma has clinically worsened since a neoplasm naturally will worsen with the passage of time. The development of a metastasis after the excision of the primary malignant melanoma is likely to be part of the natural history of this unpredictable neoplasm.

The treatment of a primary malignant melanoma would include surgical excision of the tumour with adequate margin, and appropriate follow-up.