Ulceration
This input is used for staging
Description
Ulceration, the absence of an intact epidermis overlying the primary melanoma based upon histopathological examination, is a prognostic factor for melanoma of the skin. Ulceration is the formation of a break on the skin or on the surface of an organ. An ulcer forms when the surface cells die and are cast off. Ulcers may be associated with cancer and other diseases. Primary tumor ulceration has been shown to be a dominant independent prognostic factor, and if present, changes the pT stage from T1a to T1b, T2a to T2b, etc., depending on the thickness of the tumor. The presence or absence of ulceration must be confirmed on microscopic examination. Melanoma ulceration is defined as the combination of the following features * Full-thickness epidermal defect (including absence of stratum corneum and basement membrane) * Evidence of reactive changes (i.e., fibrin deposition, neutrophils); and thinning, effacement, or reactive hyperplasia of the surrounding epidermis in the absence of trauma or a recent surgical procedure * Ulcerated melanomas typically show invasion through the epidermis, whereas nonulcerated melanomas tend to lift the overlying epidermisNotes
**Note 1:** **Physician Statement** * Physician statement of microscopically confirmed ulceration (e.g., based on biopsy or surgical resection) can be used to code this data item when no other information is available. **Note 2:** **Ulceration defined** * Melanoma ulceration is the absence of an intact epidermis overlying the primary melanoma based upon microscopic (histopathological) examination. * Ulceration can only be confirmed by microscopic examination. Do not use findings from physical exam. * It is possible for a patient to present with an ulcerated lesion noted on physical exam, but this is not the same thing as ulceration seen on a microscopic exam| Code | Description |
|---|---|
| 0 | Ulceration not identified/not present |
| 1 | Ulceration present |
| 8 | Not applicable: Information not collected for this case (If this item is required by your standard setter, use of code 8 will result in an edit error.) |
| 9 | Not documented in medical record Cannot be determined by the pathologist Pathology report does not mention ulceration Ulceration not assessed or unknown if assessed |