NQMC Update Service: July 30, 2012 ▲ American College of Surgeons ▲ MELANOMA

New This Week

Measure Summaries

American College of Surgeons

• Melanoma: is the surgeon who performs sentinel lymph node biopsy (SLNB) or lymph node dissection (LND) for melanoma certified by the American Board of Surgery or equivalent board or international association?

• Melanoma: percentage of patients newly diagnosed with stage IV melanoma for whom a serum lactate dehydrogenase (LDH) level is measured.

• Melanoma: percentage of patients to undergo a sentinel lymph node biopsy (SLNB) for melanoma for whom lymphoscintigraphy is performed to identify the draining nodal basin(s) when drainage to more than one basin is possible.

• Melanoma: percentage of patients treated for melanoma for whom stage-specific follow-up, including future skin exams, is discussed and documented.

• Melanoma: percentage of patients who have a resected primary melanoma metastatic to regional lymph nodes or distant sites for whom there is a documented discussion regarding adjuvant therapy.

• Melanoma: percentage of patients who have a stage Ib or II melanoma with whom sentinel lymph node biopsy (SLNB) is discussed.

• Melanoma: percentage of patients who have stages 0, I, or IIA melanoma for whom an abdominal CT/MRI, pelvic CT/MRI, or PET scan was not performed, except in response to specific signs or symptoms.

• Melanoma: percentage of patients who undergo a cervical lymph node dissection (LND) or completion lymph node dissection (CLND) for melanoma for whom at least 15 regional lymph nodes are resected and pathologically examined.

• Melanoma: percentage of patients who undergo a sentinel lymph node biopsy (SLNB) for melanoma for whom the sentinel lymph nodes (SLNs) are examined with serial sectioning/hematoxylin and eosin (HE) and with immunohistochemistry (IHC) if the HE analysis is negative or equivocal (i.e., S-100, HMB-45, and MART-1).

• Melanoma: percentage of patients who undergo a sentinel lymph node biopsy (SLNB) for melanoma for whom the sentinel lymph nodes (SLNs) are sent for permanent sectioning only (no frozen sections), unless a reason is documented.

• Melanoma: percentage of patients who undergo a sentinel lymph node biopsy (SLNB) or lymph node dissection (LND) for melanoma for whom the pathology report documents the number of lymph nodes examined and the number of lymph nodes found to contain metastases.

• Melanoma: percentage of patients who undergo an axillary lymph node dissection (LND) or completion lymph node dissection (CLND) for melanoma for whom at least 10 regional lymph nodes are resected and pathologically examined.

• Melanoma: percentage of patients who undergo an inguinal lymph node dissection (LND) or completion lymph node dissection (CLND) for melanoma for whom at least five regional lymph nodes are resected and pathologically examined.

• Melanoma: percentage of patients with a melanoma 1-2 mm thick (i.e., T2) for whom the surgical excision margins are 1-2 cm (or the specific anatomic or cosmetic factors that limit margin distance are noted).

• Melanoma: percentage of patients with a melanoma for whom a clear histologic margin is documented.

• Melanoma: percentage of patients with a melanoma for whom the pathology report documents Breslow thickness, Clark level, histologic ulceration, peripheral/radial and deep margin statuses, satellitosis, anatomic location of the lesion, regression, and mitotic rate.

• Melanoma: percentage of patients with a melanoma for whom the surgeon documented the measured surgical margin in the operative report.

• Melanoma: percentage of patients with a melanoma greater than or equal to 2 mm thick (i.e., T3 or T4) for whom the surgical excision margins are 2-3 cm (or the specific anatomic or cosmetic factors that limit margin distance are noted).

• Melanoma: percentage of patients with a melanoma in situ (i.e., Tis) for whom the surgical excision margins are 5 mm (or the specific anatomic or cosmetic factors that limit margin distance are noted).

• Melanoma: percentage of patients with a melanoma less than or equal to 1 mm thick (i.e., T1) for whom the surgical excision margins are 1 cm (or the specific anatomic or cosmetic factors that limit margin distance are noted).

• Melanoma: percentage of patients with melanoma and clinically apparent/palpable lymphadenopathy for whom a lymph node dissection (LND) is performed without an antecedent histologic diagnosis.

• Melanoma: percentage of patients with melanoma having biopsy-proven or palpable nodal disease and no evidence of distant metastases who undergo a lymph node dissection (LND).

• Melanoma: percentage of patients with melanoma who have a metastatic lymph node detected on sentinel lymph node biopsy (SLNB) for whom a complete lymph node dissection (CLND) is performed except in the context of a clinical trial or if the patient has severe comorbidities.

• Melanoma: percentage of patients with melanoma who have biopsy-proven, palpable nodal disease who do not undergo sentinel lymph node biopsy (SLNB).

Melanoma: percentage of patients with melanoma who have clinically palpable nodal disease of the inguinofemoral nodes for whom a pelvic computed tomography (CT) or positron emission tomography (PET) is obtained to rule out pelvic lymphadenopathy.