Claimant #6 CPTD 166,855.00 appears
to have rare skin cancer called mycosis fungoides. Has had chemo
and radiation, no further info but will need a review of underwriting and possible stop loss underwriting. Spec is $125k 12/15
Mycosis Fungoides is actually a cutaneous (on the skin) T-cell lymphoma.
Patients usually present with a skin rash and perhaps some enlarged
lymph nodes. Biopsy reveals the malignant cells. The stage
of the disease is determined by how far it has spread into the surface
area of the skin as well as lymph node involvement and distant mets.
Treatment is based on stage and prior treatment history. In general,
topical therapies are indicated for Stage I patients, and systemic
therapies or combinations of topical and systemic therapies are indicated
for patients with stage IIB or greater. The systemic therapies
include interferon alfa, monoclonal antibodies and chemotherapy along
with others. The most common chemotherapeutic is Methotrexate. There
are reports of allogenic transplants used for this disorder in some
patients.
This patient likely has more advanced disease and is receiving either
chemotherapy or antibody therapy. Questions to ask would be what stage,
planned ongoing treatment and whether BMT is being considered. This
is an incurable condition in most patients, with the exception of
those with stage IA disease and more advanced disease has a life
expectancy of less than 5 years. Stage IV disease has a life
expectancy of less than 1.5 years. Finally, secondary malignancies
are common in these patients such as melanoma and colon cancer.
AMS Recommendation:
The $125k spec likely will
not be adequate if BMT is considered, therefore stop loss underwriting will be required. With the information
provided, a laser of $165-$170k is recommended for similar claims
in the upcoming policy period.
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