CS Tumor Size. We re on the Web! Visit us at www2.kumc.edu/kcr

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1 VOLUME 17 ISSUE 3 July 2013 We re on the Web! Visit us at www2.kumc.edu/kcr July is UV Awareness Month. It is that time of the year again for summer! This is a great opportunity to talk about skin cancer. Skin cancer is the most common of all cancers. Melanoma accounts for less than 5% of skin cancer cases. There are many ways to reduce your risk of skin cancer: Limit UV exposure Wear a hat Wear sunglasses Use sunscreen and lip balm of at least SPF 15 Stay in the shade as much as possible Check for abnormal moles and have them removed It is important to check your skin once a month for any unusual moles, freckles or other markings. The risk of getting melanoma is about 1 in 50 for Caucasians, 1 in 1,000 for African Ameircans, and 1 in 200 for Hispanics. CS Tumor Size For the Collaborative Stage Tumor Size for Melanoma this is the recoded size of the tumor in millimeters not the depth or thickness. Depth or thickness is recorded in Site Specific Factor 1 in the Measured Thickness, Breslow s Measurement table.

2 Why is text important? Provides the patient s cancer information in a readable format. Text information is readily available to defend coded items without going back to the source document. Documents unusual occurrences. Verifies edit checks. Central registry staff use text to verify coding discrepancies between facilities for the same patient. Provides information for: o recoding audits part of quality control at the central registry o researcher use confirm validity of data o facility use defend codes, document treatment from outside facilities o re-abstraction of historical data comparisons registrars can compare data by recoding the historical data to compare to more current data Examples of validating codes with text: Patient demographic codes: o Race code: 02 o Hispanic code: 0 o Sex code: 2 Text justification for patient demographic codes: B/F, non Hispanic Cancer ID and stage codes o Primary site: C341 o Histology: 8140 o Behavior: /3 o Grade: 2 o Tumor size: 020 o Laterality: 1 o Regional LNs positive: 00 o Regional LNs examined: 03 Text justification for Cancer ID and stage codes from pathology report 8/7/2007: Lobectomy of the right upper lobe lung reveals a moderately differentiated invasive adenocarcinoma measuring 2cm in greatest diameter. Three hilar lymph nodes are removed and are negative for carcinoma. Margins are negative. Abbreviated text justification for Cancer ID and stage codes 8/7/2007: Lobectomy RUL lung: mod diff inv adenoca. TS 2cm. 3 hilar LN removed, neg for ca. Margins neg.

3 Examples of Validating Codes with Text First course treatment information o Surgery primary site: 22 text justification Lumpectomy o Scope LNS surgery: 2 text justification SLN Bx o Chemotherapy: 87 text justification Refused o Radiation therapy: 7 - text justification Refused o Date hormone tx: 07/10/07 o Hormone therapy: 01 text justification Administered Follow-up and recurrence o Type last tumor follow-up: 01 text justification Readmit o Vital status: 1 text justification Alive o Recurrence type: 00 text justification None/disease-free NAACCR Approved Abbreviations Adenoca: Adenocarcinoma Ant: Anterior Bil: Bilateral Ca: Carcinoma Cont: Continue Dz: Disease Dx: Diagnosis Exc: Excision Lg Large Mets Metastatic, Metastases Rx Treatment Sx Symptoms Tx Treatment W/ With W/O Without W/U Workup NAACCR Approved At / Comparison < Less than, decrease = Equals > Greater than, increase - Negative + Positive X Times Reference:

4 What would be the correct surgical senario for this melanoma case? Patient presents s/p biopsy in Derm offce with melanoma 0.5mm,close to tissue edges. Our institution; Wide resection allowing for approx 1cm margins in all directions from the lesion; Path; residual melanoma insitu close to prior bx site. Our institution : re excision., Path- no residual melanoma Based on info provided it is 27, 30, 30. Patient came to our facility, excision of lesion on path read as "possible" solar lentigo in June. Consult at outside path lab read the specimen as melanoma in situ and was dated in August. What is the date of first contact AND the date of diagnosis? The date of first contact at your facility is the date the specimen was taken. It should be used to code the date of excision of lesion, date of diagnosis, and date of 1st contact. Pathology report states Wide excision with margins: Negative, Peripheral: at least 1.5cm & Deep: 0.8cm. Do both the Peripheral and Deep Margins need to be >1cm to qualify for codes 45-47? It is applicable to all margins. Is Evolving Melanoma reportable? The melanoma with behavior /2 and /3 is reportable. The term evolving does not automatically mean the behavior is borderline. I would recommend to clarify the behavior with pathologist. I have a case with the following listed in the final path of the shave biopsy: malignant melanoma, at least 1.15mm in thickness with deeper perifollicular nests at a depth of 1.36mm, a microsatellite focus at a depth of 1.7mm and a nest deeper in the dermis adjacent to an involved eccrine duct at a depth of 2.3mm. Anatomic level IV. margins are positive. Patient then goes on to have an excision and that final path shows: malignant melanoma, superficial spreading type, invasive to a depth of 1.01mm, anatomic level IV. Margins are negative. What would the correct depth be to code in SSF1? In this case, code the depth from the final pathology report of the Excision procedure of 1.01mm as 101. Patient has melanoma of scalp and a few months after resection has in transit mets in scalp near the skin graft. What is the best code for 'type of recurrence'? Most likely it is local, but if the mets originate in the scar, then it can be coded trocar. Do you have any questions that you would like answered in an upcoming newsletter? your question(s) to: vhundley@kumc.edu

5 Reporting Schedule Month of Diagnosis Due to KCR by: January 2013 July 2013 February 2013 August 2013 March 2013 September 2013 April 2013 October 2013 May 2013 November 2013 June 2013 December 2013 July 2013 January 2014 August 2013 February 2014 September 2013 March 2014 October 2013 April 2014 November 2013 May 2014 December 2013 June 2014 Are You Current? Use NAACCR Record Layout Version 12.2 for transmitting 2012 cases and NAACCR Version 12.2 Edits for error checking. NAACCR Record Layout Version 13 and NAACCR Version 13 Edits have been released and are effective for cases diagnosed in We have converted the KCR database to v13 and can accept v13 and prior files. Due to the limited number of changes between v13 and v12.2, cases diagnosed in 2013 may be abstracted and transmitted to KCR using v12.2 standards if necessary. Please contact your registry software vendor when you are ready to convert to v13. KCR will distribute updated Abstract Plus software later this summer. Use Collaborative Staging & Coding Manual, Version (released December 2011) ( to code collaborative stage fields for 2012 and 2013 cases. Use the 2012 Hematopoietic & Lymphoid Database and Manual for 2012 and 2013 cases. The 2012 database is available as a web-based version at or as a software download at The web-based version is the preferred method to access the current data. Both versions include the Multiple Primaries Calculator and the current Hematopoietic Coding Manual. Please pay close attention to pages for new histology terms and codes. Please check our website to download the Kansas Cancer Registry Coding and Information Manual, ( Use Multiple Primary and Histology Coding Rules Manual (Revised September 27, 2011) ( for all cases diagnosed January 1, 2007 and forward.

6 ICD-9-CM Codes Case Finding List 2013 Explanation of ICD-9CM Code 140._ _, Malignant neoplasms, stated or presumed to be primary (of specified sites), and certain 174._ , 209.7_ specified histologies (Except ) Benign neoplasms of brain and spinal cord neoplasm 227.3, Benign neoplasm of pituitary gland, craniopharyngeal duct (pouch) and pineal gland Hemangioma; of intracranial structures Lymphangioma, any site Note: Includes only lymphangioma of the brain, other parts of nervous system and endocrine gland Carcinoma in situ (Except and 233.1) , 237.6, Neoplasm of uncertain behavior of endocrine glands and nervous system: pituitary gland, craniopharyngeal duct and pineal gland Neoplasm of uncertain behavior of endocrine glands and nervous system: brain and spinal cord, meninges, endocrine glands and other and unspecified parts of nervous system Polycythemia vera (9950/3) Plasma cells 238.7_ 239.6, Other lymphatic and hematopoietic diseases Neoplasms of unspecified nature, brain, endocrine glands and other parts of nervous system Macroglobulinemia (Waldenström's macroglobulinemia) Other specified disorders of metabolism Reportable includes terms: Hand-Schuller-Christian disease; histiocytosis (acute) (chronic); histiocytosis X (chronic) Hemophagocytic syndrome (histiocytic syndromes) Familial polycythemia (syndrome for polycythemia vera) 795.0_ _ 796.7_ Papanicolaou smear of cervix and vagina with cytologic evidence of malignancy Abnormal cytologic smear of anus and anal HPV V10.0_ - V10.9_ Personal history of malignancy Note: Screen for recurrences, subsequent primaries, and/or subsequent treatment V12.41 Personal history of benign neoplasm of the brain V58.0, V58.1_ V67.1, V67.2 V76._ V86._ Encounter for radiotherapy, chemotherapy, immunotherapy Follow up examination: following radiotherapy or chemotherapy Special screening for malignant neoplasm Estrogen receptor positive status [ER+], negative status (ER-)

7 Updating Contact Information! Please visit our website (www2.kumc.edu/kcr/downloads) Submit the updated form to Victoria Hundley ( Fax: ) The Kansas Cancer Registry (KCR), under the direction of Dr. Sue Min Lai, has expanded in recent years to collect and maintain a population based longitudinal database of all Kansans diagnosed with cancer. KCR is the only population-based source of information on cancer incidence in the State of Kansas. It provides information on the occurrence of cancer, stage at diagnosis, survival and subpopulations affected by different types of cancer. Registry information can be used by researchers to evaluate the effectiveness of new treatments and by public health professionals to implement and monitor prevention efforts. Thanks to facilities across the state of Kansas who report cancer cases, KCR has quality data to help in the fight against cancer. KCR Staff Sue-Min Lai SLAI@kumc.edu John Keighley JKEIGHLE@kumc.edu Sarma Garimella SGARIMEL@kumc.edu Christi Baron CBARON@kumc.edu Qin Wang QWANG@kumc.edu Jessica Jungk JJUNGK@kumc.edu Victoria Hundley VHUNDLEY@kumc.edu Thanks to all KCR staff members who contributed to the publication of this newsletter. Kansas Cancer Registry University of Kansas Medical Center 130 Support Services, MS Rainbow Boulevard, Kansas City, Kansas Tel: Fax: