V.1.4 Special Conditions - Primary Site

For leukemia and lymphoma cases diagnosed January 1, 2010 and forward, or following installation of CSv2 software, please refer to the 2010 Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database.

Special rules apply to the following tumors:

Subareolar/Retroareolar Tumor

Code as the central portion of the breast (C50.1), which indicates that the tumor arose in the breast tissue beneath the nipple, but not in the nipple itself.

Ductal and Lobular Breast Lesions

See Section II.1.3.4 for a discussion of certain mixed ductal and lobular lesions of the female breast. If these lesions occur in different quadrants of the same breast, the site code is C50.9.

Melanoma

If the primary site is unknown, assume the primary site is the skin and enter C44.9.

Unless it is stated to be a recurrent or metastatic melanoma, record each melanoma as a separate primary when any of the following apply:

• The occurrences are more than two months apart
• The fourth character of the ICD-O topography code for skin (C44._) is different
• The first three digits of the ICD-O-3 morphology code are different
• An in situ melanoma is followed by an invasive melanoma
• The occurrences are within the same sub-site code, but different lateralities or different trunk sides, such as chest and back

Neuroblastoma

Code neuroblastomas of ill defined sites for the most likely site in each case.  (Adrenal medulla is a common site.)  If the location of the primary tumor is unknown, code as connective, subcutaneous, and other soft tissue, NOS (C49.9).

Kaposi's Sarcoma

Code the primary site as the site in which the tumor arises. If Kaposi's sarcoma arises in the skin and another site simultaneously, or if no primary site is stated, code the primary site as skin (C44._).

Familial Polyposis

When multiple carcinomas arising in familial polyposis involve multiple segments of the colon or the colon and rectum, code the primary site as colon, NOS (C18.9).

Colon

If there is no other information given regarding subsite except for the measurement given in the colonoscope, the measurement may be used to assign subsite. If the colonoscope measurement is used to assign a specific subsite, the CCR’s standard reference is the colon diagram in the AJCC Cancer Staging Manual, 5^th Edition, page 85. A copy of this diagram is also available in DSQC Memo 2000-04, page 2. (Note, select DSQC Memo 2000-04 from the 2004 folder that will be visible in the Historical DSQC Memo interactive book.)

If there is conflicting information in the medical record with regard to subsite and there is no surgical resection, code the subsite as stated by the physician. If there is a surgical resection, code the subsite as stated in the operative report, or a combination of the operative report and the pathology report.

For historic coding instructions, please click here.

 

 

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