What is the N1S3 staging system for metastatic cutaneous squamous cell carcinoma (cSCC)?

Updated: Jul 08, 2020
  • Author: Talib Najjar, DMD, MDS, PhD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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In early 2010, Milross et al proposed an alternative nodal staging system for metastatic cSCC of the head and neck. This system, called N1S3, stages cSCC on the basis of the number (single or multiple) and size (smaller or larger than 3 cm) of lymph nodes involved, as well as incorporating the parotid as one of the regional levels. [44]

The stages of N1S3 are as follows:

  • Stage I - A single lymph node measuring 3 cm or less

  • Stage II - A single lymph node greater than 3 cm, or multiple lymph nodes measuring 3 cm or less

  • Stage III - Multiple lymph nodes greater than 3 cm

The N1S3 system was found to have a significant predictive capacity for locoregional control, disease-specific survival, and overall survival in a group of 215 patients. Testing in a different cohort of 250 patients provided validation of its predictive capacity. [44]

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