Division Co-Chiefs: Andrew L. Pecora, MD, James Wittig, MD
Quality Indicators
(Medical/Surgical/Radiation):
- Initial diagnostic work-up is at 95% compliance
- All melanoma patients with node positive disease are offered adjuvant therapy.
- Documentation that all patients with skin cancer have been taught how to do a self skin exam.
All Patients
- All patients with solid tumors are staged according to ACoS standards.
- All patients who are receiving chemotherapy have a plan documented prior to administration of therapy.
Diagnostic Work Up:
Invasive Melanoma of Skin
| ICD 9 Codes |
| 172.0 |
| 172.1 |
| 172.2 |
| 172.3 |
| 172.4 |
| 172.5 |
| 172.6 |
| 172.7 |
| 172.8 |
| 172.9 |
|
| Diagnostic Work Up (4 Scenarios) |
|
1. Lesion < 0.75mm deep
|
|
Exam/Test
|
|
Wide excision only
|
|
Pathology review
|
|
Chest x-ray
|
|
Chemistry panel
|
|
2. Lesion is 0.75mm deep, but < 1.0mm deep
|
|
Exam/Test
|
|
Good Risk: No adverse features
|
|
Wide excision only
|
|
Pathology review
|
|
Chest x-ray
|
|
Chemistry panel
|
|
Poor Risk: Ulceration, Clarks level IV, Signs of regression, Marked pleomorphism, or Shave biopsy
|
|
Wide excision with sentinel node biopsy
|
|
Pathology review
|
|
PET/CT Scan
|
|
MRI Brain with and without gadolinium
|
|
Chemistry panel
|
|
3. Lesion > 1.0mm deep
|
|
Exam/Test
|
|
Wide excision with sentinel node biopsy
|
|
Pathology review
|
|
PET/CT Scan
|
|
MRI Brain with and without gadolinium
|
|
Chemistry Panel
|
|
4. Metastases on presentation
|
|
Exam/Test
|
|
PET/CT Scan
|
|
MRI Brain with and without gadolinium
|
|
Chemistry panel
|
|
|
Uveal Melanoma
|
|
| Diagnostic Work Up |
|
1. Small
|
|
Exam/Test
|
|
Radiation plaque therapy
|
|
PET/CT Scan
|
|
MRI Brain with and without gadolinium
|
|
2. Large
|
|
Exam/Test
|
|
Enucleation
|
|
PET/CT Scan
|
|
MRI Brain with and without gadolinium
|
|
MRI Liver with and without gadolinium (if PET/CT equivocal)
|
|
|
Invasive Squamous Cell Cancer
| ICD 9 Codes |
| 173.0 |
| 173.1 |
| 173.2 |
| 173.3 |
| 173.4 |
| 173.5 |
| 173.6 |
| 173.7 |
| 173.8 |
| 173.9 |
|
| Diagnostic Work Up |
| Test/Exam: |
|
CT Chest
|
|
Chemistry panel
|
|
|
Bone Cancer
| ICD 9 Codes |
| 170.0 |
| 170.1 |
| 170.2 |
| 170.3 |
| 170.4 |
| 170.5 |
| 170.6 |
| 170.7 |
| 170.8 |
| 170.9 |
| 238.0 |
| 198.5 |
| 195.3 |
| 195.4 |
| 195.5 |
| 195.8 |
| 202.9 |
| 198.89 |
| 239.2 |
|
| Diagnostic Work Up |
| Test/Exam: |
|
History and Physical Examination
|
|
CBC
|
|
Chem 20
|
|
PT/PTT
|
|
CRP
|
|
ESR
|
|
SPEP (Serum Protein Electrophoresis; suspected myeloma)
|
|
Xrays of Extremity
|
|
MRI of Bone/Extremity with gadolinium
|
|
CT of Bone and Extremity +/- contrast
|
|
Whole Body Bone Scan
|
|
CT Chest +/- Contrast
|
|
CT Abdomen and Pelvis +/- contrast
|
|
PET/CT Scan whole body:
|
|
~ May be substituted in lieu of CT Chest, Abdomen and Pelvis
|
|
~ Necessary in cases of multicentric tumors or tumors with unusual patterns of metastases
|
|
Thallium Scan (Osteosarcoma)
|
|
Pathologic Review:
|
|
~ Cytogenetics
|
|
~ Immunostains (Panel)
|
|
~ Routine Histology
|
|
~ Ewing’s Sarcoma Translocation: t11;22 t21;22 t7;22 t17;22 t2;22
|
|
~ Osteosarcoma: Her-2/neu gene, Retinoblastoma gene, P53 gene
|
|
~ Small Cell Osteosarcoma: t11;22
|
|
~ Lymphoma of Bone: Flow Cytometry
|
|
~ Eosinophilic Granuloma: Electron Microscopy
|
|
|
Soft Tissue Cancer
| ICD 9 Codes |
| 171.0 |
| 171.2 |
| 171.3 |
| 171.4 |
| 171.5 |
| 171.6 |
| 171.7 |
| 171.8 |
| 171.9 |
| 238.1 |
| 176.1 |
| 239.2 |
|
| Diagnostic Work Up |
| Test/Exam: |
|
History and Physcial Examination
|
|
Xrays of Site
|
|
MRI of Site/Extremity with gadolinium
|
|
CT of Site/Extremity +/- contrast
|
|
CT Chest, Abdomen, Pelvis with contrast
|
|
PET/CT Scan whole body for specific tumors with unusual patterns of metastases (substitute for CT Chest, Abdomen, Pelvis)
|
|
Whole Body Bone Scan
|
|
Pathologic Review:
|
|
~ Cytogenetics
|
|
~ Immunostains (Panel)
|
|
~ Routine Histology
|
|
~ Liposarcoma: Myxoid/Round Cell Type: t12;16
|
|
~ Synovial Sarcoma: tX;18 (SYT-SSX)
|
|
~ Soft Tissue Ewing’s Sarcoma : t11;22 t21;22 t7;22 t17;22 t2;22
|
|
~ Soft Tissue Osteosarcoma: Her2-neu, RB gene, p53 gene
|
|
~ Rhabdomyosarcoma: t2;13 t1;13 PAX3/FKHR Fusion Gene
|
|
~ Vascular Tumors: VEGFR-3
|
|
~ Clear Cell Sarcoma: t12;22
|
|
|
Other Skin Cancer
| ICD 9 Codes |
| 173.0 |
| 173.1 |
| 173.2 |
| 173.3 |
| 173.4 |
| 173.5 |
| 173.6 |
| 173.7 |
| 173.8 |
| 173.9 |
| 238.2 |
| 239.2 |
|
| Diagnostic Work Up |
| Test/Exam: |
|
History and Physcial Examination
|
|
PET/CT Scan whole body
|
|
Pathologic Review:
|
|
~ Routine Histology
|
|
~ Cytogenetics
|
|
~ Immunohistochemistry
|
|
|
Kaposi's Sarcoma
| ICD 9 Codes |
| 176.0 |
| 176.1 |
| 176.2 |
| 176.3 |
| 176.4 |
| 176.5 |
| 176.8 |
| 176.9 |
|
| Diagnostic Work Up |
| Test/Exam: |
|
History and Physcial Examination
|
|
PET/CT Scan whole body
|
|
Pathologic Review:
|
|
~ Routine Histology
|
|
~ Cytogenetics
|
|
~ Immunohistochemistry
|
|
|
Skin in Situ
| ICD 9 Codes |
| 232.0 |
| 232.1 |
| 232.2 |
| 232.3 |
| 232.4 |
| 232.5 |
| 232.6 |
| 232.7 |
| 232.8 |
| 232.9 |
| 238.2 |
|
| Diagnostic Work Up |
| Test/Exam: |
|
History and Physcial Examination
|
|
PET/CT Scan whole body
|
|
Pathologic Review:
|
|
~ Routine Histology
|
|
~ Cytogenetics
|
|
~ Immunohistochemistry
|
|
|
