Skin Lesion

Supplementary information to be read in conjunction with the pathway Reference Supplementary Information 1.0 Changing skin Changing skin growth/lesion causing concern. Worrying skin lesion as identified by patient health professional relative or friend. In the UK 8000 Malignant Melanoma (MM) diagnosed per year (in 2001 6432 new MM in England + Wales with 1500 deaths). GPs will see 1 malignant melanoma approximately every 5 years. Data from 2001 for NMSC: 65 per 100,000 in females and 96 per 100,000 in males. BCC to SCC ratio of 4:1. 400 deaths /year from NMSC in UK Possible malignant melanoma or squamous cell carcinoma require rapid referral via the 2 week skin cancer pathway 1.3 Self Assessment & Self Care WORKFORCE FUNCTIONS-Support individuals to undertake and monitor their own healthcare-Support individuals to undertake and monitor their own healthcare-Obtain information from individuals to support assessment of their health status and needs (History Taking)-Receive and direct requests for health care assistance using protocols and guidelines 1.3 Self Assessment & Self Care Support for patients in understanding their condition and choices available through NHS Direct and NHS Choices. For more information see the pathway web page. 1.6 Escalation thresholds & decision aids WORKFORCE FUNCTIONS-Receive and direct requests for health care assistance using protocols and guidelines-Refer individuals to specialist services for treatment and care 1.6 Escalation thresholds & decision aids Support for patients in understanding their condition and choices available through NHS Direct and NHS Choices. For more information see the pathway web page. 1.7 Red Flags Change in size shape or colour, new mole, scaly, scabbing, bleeding, crusting, changing moles should all be referred into primary care for review Workforce and Equipment: Dermoscopy, provided the clinician in suitably trained, may be a service provided in primary care IT Requirements: Telemedicine links may be considered in some geographical areas. There is little evidence to date that telemedicine is a useful addition to pathways. In a recent study on the efficiency of resource allocation in teledermatology it took one consultant session and 2 sessions of specialist dermatology nurses to see 18 patients. 60% of these were then required to attend the hospital. This compares poorly with normal clinic allocation of resources. It applies to the model of teledermatology as "substitute for consultation" rather than as "supplement to telephone". (Source: British Teledermatology Society 2007)

Providers should report all services using the most up-to-date industry-standard procedure, revenue, and diagnosis codes, including modifiers where applicable.
The following codes are included below for informational purposes only; this is not an all-inclusive list.

CPT Codes
There are not specific CPT codes for this service

Description
Melanoma is a form of skin cancer that originates in the pigment-producing melanocytes. Most melanocytes produce melanin and the tumors are commonly pigmented brown or black. Melanoma is less common than basal and squamous cell skin cancer, but it is more likely to metastasize than other skin cancers. Prognosis is highly associated with stage of the disease at diagnosis, characterized by the depth of the tumor, the degree of ulceration and the extent of spread to lymph nodes and distant organs. For example, for thin (ie, <1.0 mm) localized stage 1 cancers the 5-year survival rate is over 90% and this decreases to around 15% to 20% for metastatic stage IV cancers. 1 Thus, early detection of disease is important for increasing survival.
Differentiating melanoma lesions from benign pigmented lesions in the clinical setting is challenging. Diagnostic aids such as the ABCDE rule have been developed to assist clinicians when they visually inspect suspicious lesions. The diagnostic accuracy of the ABCDE criteria varies depending on whether they are used singly or together. Use of a single criterion is sensitive but not specific, which would result in many benign lesions being referred or biopsied. Conversely, use of all criteria together is specific but not sensitive, meaning that a number of melanomas are missed.
There is interest in noninvasive approaches that will improve the diagnosis of malignant skin lesions. One technique is dermatoscopy (also called dermoscopy), which enables the clinician to perform direct microscopic examination of diagnostic features in pigmented skin lesions. Devices consist of a 10x magnifier lens in combination with a liquid medium or polarized light to eliminate reflection and allow for more-detailed examination of suspicious skin lesions. The available evidence from prospective randomized controlled trials and other studies suggests that dermatoscopy used by specialists may lead to a decrease in the number of benign lesions excised and, when used by primary care physicians, may lead to fewer benign lesions being referred to specialists.
Another technology that can potentially improve melanoma detection and outcomes is multispectral digital skin lesion analysis (MSDSLA). A U.S.

Summary
There is interest in noninvasive devices that will improve the diagnosis of malignant skin lesions. One such approach is multispectral digital skin lesion analysis (MSDSLA). This technique has the potential to improve diagnostic accuracy for suspicious skin lesions and may increase the detection rate of malignant skin lesions and/or reduce the rate of unnecessary biopsies.
The evidence for MSDSLA in patients who have pigmented lesions being evaluated for melanoma includes 2 prospective diagnostic accuracy studies and several online studies or simulation exercises addressing clinical utility. Relevant outcomes are overall survival, disease-specific survival, test accuracy and validity, other test performance measures, and change in disease status. The diagnostic accuracy study found that MSDSLA had a sensitivity of 98.2% for recommending biopsy of melanoma lesions (8% of the pigmented lesions were melanoma). The average specificity of MSDSLA was 9.5% compared with 3.7% among clinicians. However, the study included only lesions that had already been determined by a clinician to be sufficiently suspicious to warrant excision. The online randomized controlled trial included images of a subset of lesions from the diagnostic accuracy study. The sensitivity and specificity of a correct biopsy decision was significantly higher among dermatologists who had MSDSLA results than among those who only had clinical information and digital images. Study participants did not actually examine patients. There are no studies conducted in a clinical setting that evaluate the utility of MSDSLA as a diagnostic tool in the initial evaluation of pigmented lesions. In addition, there are no studies conducted in clinical settings that compared patient management decisions and health outcomes with and without these devices. The evidence is insufficient to determine the effects of the technology on health outcomes.

Date
Action 1/2021 Clarified coding information 2/2018 Annual policy review. New references added. 1/2017 Annual policy review. New references added.

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