Current RMA Instruments:
| Reasonable Hypothesis SOP | 102 of 2015 |
| Balance of Probabilities SOP | 103 of 2015 |
Changes from Previous Instruments:
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.