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Non Melanotic Malignant Neoplasm of the Skin B046

Last amended 
17 March 2016
Current RMA Instruments:
Reasonable Hypothesis SOP
7 of 2016
Balance of Probabilities SOP
8 of 2016
Changes from previous Instruments:

SOP Bulletin 188

ICD Coding:
  • ICD-9-CM Codes: 140.0,140.1,140.6,140.9,173,187.1,187.2,187.3,187.4,187.7,232,233.5,233.6
  • ICD-10-AM Codes: C00.0, C00.1, C00.2, C00.6, C44.0-9, C60.0, C60.1, C60.2, C60.9, C63.2, D04.0-9, D07.4, D07.6
Brief description:

This SOP covers:

  • the common non-melanoma skin cancers - basal cell carcinoma (BCC) and squamous cell carcinoma of the skin (SCC);
  • some rarer types of skin cancer - Merkel cell carcinoma, basosquamous carcinoma;
  • carcinoma-in-situ of the skin (but not solar ketatosis).
Confirming the diagnosis:

To confirm the diagnosis there needs to be a histology report or other clear evidence of basal cell carcinoma, squamous cell carcinoma, carcinoma-in-situ, Merkel cell carcinoma or basosquamous carcinoma of the skin.

If the veteran has claimed solar skin damage (or similar) and also has solar keratosis, that condition should be diagnosed and determined as well.

The relevant medical specialist is a dermatologist or plastic surgeon.

Diagnoses covered by SOP
  • Basal cell carcinoma (BCC) of the skin
  • Bowen’s disease
  • Carcinoma-in-situ of the skin
  • Merkel cell carcinoma
  • Squamous cell carcinoma (SCC) of the skin
  • BCC or SCC of anogenital skin (including skin of penis)
  • Non-melanotic malignant neoplasm of the lip (lipstick area)
Conditions not covered by SOP
  • Kaposi’s sarcoma of the skin*
  • Keratoacanthoma#
  • Lymphoma of the skin* - Hodgkin's lymphoma or non-Hodgkin's lymphoma
  • Malignant melanoma of the skin*
  • Soft tissue sarcoma* of the skin
  • Solar keratosis*

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

# non-SOP condition

Clinical onset

Clinical onset will generally be when the first (non-melanoma) skin cancer, subsequently confirmed by histology, was clinically diagnosed by a doctor.  The earlier presence of a skin lesion at the site does not establish a clinical onset, as the cancer may have arisen in a previously benign skin lesion.

Clinical worsening

For worsening, the SOP has only an inability to obtain appropriate clinical management factor.  Failure to undergo timely treatment could result in permanent worsening in the form or local invasion/ destruction of normal tissue, or rarely, metastasis or death from the disease.

Further comments:

Procedural Note:  If the condition you are investigating is a Merkel cell carcinoma,  then use an appropriate ICD code from the range 140.0, 140.1, 140.6, 140.9, 173, 187.1, 187.2, 187.3, 187.4, 187.7, 232, 233.5, or 233.6 that best matches the body part for the claimed condition.  Codes for this type of carcinoma are not currently available in the selectable range in CCPS.