How is cutaneous squamous cell carcinoma (cSCC) staged?

Updated: Jul 08, 2020
  • Author: Talib Najjar, DMD, MDS, PhD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

The TNM staging system for nonmelanoma skin cancers, including cSCC, is as follows (see also Table 1, below) [30] :

Primary tumor (T)

  • TX: Primary tumor cannot be assessed

  • T0: No evidence of primary tumor

  • Tis: Carcinoma in situ

  • T1: Tumor 2 cm or less that has fewer than 2 high-risk features

  • T2: Tumor larger than 2 cm or tumor of any size with 2 or more high-risk features

  • T3: Tumor with invasion of maxilla, mandible, orbit, or temporal bone

  • T4: Tumor with invasion of axial or appendicular skeleton or perineural invasion of the skull base

High-risk features include the following:

  • Thickness >2 mm

  • Clark level 4 or higher

  • Perineural invasion

  • Ear as primary site

  • Hair-bearing lip as primary site

  • Poorly differentiated histology

Regional lymph nodes (N)

  • NX: Regional lymph nodes cannot be assessed

  • N0: No regional lymph node metastasis

  • N1: Single ipsilateral lymph node metastases ≤3 cm in greatest dimension

  • N2a: Metastasis in a single ipsilateral lymph node and >3 cm, but ≤6 cm in greatest dimension

  • N2b: Metastasis in multiple ipsilateral lymph nodes and ≤6 cm in greatest dimension

  • N2c: Metastasis in bilateral or contralateral lymph nodes and ≤6 cm in greatest dimension

  • N3: Metastasis in a lymph node and >6 cm in greatest dimension

Distant metastasis (M)

  • MX: Distant metastasis cannot be assessed

  • M0: No distant metastasis

  • M1: Distant metastasis

Table 1. Stage Grouping (Open Table in a new window)

Stage

Primary Tumor

Regional Lymph Nodes

Distant Metastasis

Stage 0

Tis

N0

M0

Stage I

T1

N0

M0

Stage II

T2

N0

M0

Stage III

T3

N0

M0

T1-3

N1

M0

Stage IV

T4

N0

M0

Any T

N2-3

M0

Any T

Any N

M1


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