Cutaneous Squamous Cell Carcinoma Takes the Stage

Highlights of the new risk-stratification scheme, with a focus on tumor characteristics


Staging is critically important for establishing cancer prognosis and treatment algorithms. The American Joint Commission on Cancer (AJCC) initiated staging systems for Merkel cell carcinoma and cutaneous squamous cell carcinoma (cSCC) because of their potential to metastasize. This "TNM" staging scheme synthesizes characteristics of the primary tumor (T), lymph nodes (N), and metastasis (M) to determine stage. This report from the cSCC staging committee focuses on T characteristics, as most cSCCs present as small primary tumors, and briefly discusses changes in N and M grading. (Changes to N criteria will be described elsewhere. Penile, vulvar, and eyelid SCC are staged separately.)

The new T grading system establishes clinical size >2 cm as a key delineator, along with high-risk features (>2-mm thickness, Clark level >IV, perineural invasion, primary location on the ear or nonglabrous lip, poorly differentiated or undifferentiated histology); invasion of maxilla, mandible, orbit, or temporal bone; and invasion of axial or appendicular skeleton or perineural invasion of the skull base. N grading includes number, size, and location (ipsilateral vs. contralateral) of involved nodes; M grading details presence or absence of distant metastasis. These features are summarized in the attached table.


Citation(s):

Farasat S et al. A new American Joint Committee on Cancer staging system for cutaneous squamous cell carcinoma: Creation and rationale for inclusion of tumor (T) characteristics. J Am Acad Dermatol 2011 Jan 21; [e-pub ahead of print].