Squamous cell carcinoma of the skin classification: Difference between revisions

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{{Squamous cell carcinoma}}
{{Squamous cell carcinoma}}
{{CMG}}; '''Associate Editor(s)-in-Chief:''' [[User:Aditya Govindavarjhulla|Aditya Govindavarjhulla, M.B.B.S.]] [mailto:agovi@wikidoc.org], [[User:Raviteja Reddy Guddeti|Raviteja Guddeti, M.B.B.S.]] [mailto:ravitheja.g@gmail.com]
{{CMG}}; {{AE}} {{RAK}}


== Overview ==
== Overview ==
Squamous cell carcinoma of the skin is a slow growing invasive non-melanoma skin [[tumour]], which is caused mainly by prolonged exposure to sunlight and other forms of UV radiation. Patients undergo staging as a routine part of their diagnosis and treatment. Staging of the lesion assists the physician to choose which form of treatment strategy suits the patient. The following is the [[TNM]] staging recommended by the [[American Joint Committee on Cancer]] (AJCC) for cutaneous SCC.


==Classification==
== Classification ==
 
{| class="wikitable"
{| style="width:80%; height:100px" border="1"
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Category
| style="width:25%" ; border="1" | '''Primary Tumour(T)'''
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Criteria
|-
|- bgcolor="LightSteelBlue"
| <center>'''TX''' </center>
| bgcolor="Beige" | Primary tumour cannot be assessed.
|-
|-
|- bgcolor="LightSteelBlue"
| colspan="2" style="background:#A9A9A9;" align="left" + |T - Primary tumor
|  <center> '''T0''' </center>
| bgcolor="Beige" | No evidence of primary tumour.
|-
|-
|- bgcolor="LightSteelBlue"
| style="background:#DCDCDC;" align="left" + |TX
| <center> '''Tis''' </center>
| style="background:#F5F5F5;" align="left" + |Primary tumor cannot be assessed
| bgcolor="Beige" | Carcinoma in situ.
|-
|-
|- bgcolor="LightSteelBlue"
| style="background:#DCDCDC;" align="left" + |Tis
|  <center> '''T1''' </center>
| style="background:#F5F5F5;" align="left" + |Carcinoma in situ
| bgcolor="Beige" |Tumour 2 cms or less in greatest dimension.
|-
|- bgcolor="LightSteelBlue"
| rowspan="3" | <center>  '''T2''' </center>
| bgcolor="Beige" | Tumour greater than 2 cms in greatest dimesion.
|-
|-
| bgcolor="Beige" | Or.
| style="background:#DCDCDC;" align="left" + |T1
| style="background:#F5F5F5;" align="left" + |Tumor ≤ to 2 cm
|-
|-
| bgcolor="Beige" | Tumour any size with >= with high risk features <sup>'''^^'''</sup>.
| style="background:#DCDCDC;" align="left" + |T2
|-
| style="background:#F5F5F5;" align="left" + | Tumor > 2 cm, and ≤ to 4 cm
|- bgcolor="LightSteelBlue"
|  <center> '''T3''' </center>
| bgcolor="Beige" |Tumour with invasion of maxilla, mandible, orbit or temporal bone.
|-
|- bgcolor="LightSteelBlue"
|  <center> '''T4''' </center>
| bgcolor="Beige" |Tumour with invasion of skelton(axial or appendicular) or perineural invasion  of skull base
|- 
|}
<sup>'''^^'''</sup>High risk features are as follows.
 
{| style="width:80%; height:100px" border="1"
| style="width:25%" ; border="1" | '''High Risk Features For Primary Tumour(T) staging'''
|-
|-
|- bgcolor="LightSteelBlue"
| style="background:#DCDCDC;" align="left" + |T3
| rowspan="3" | '''Depth/Invasion'''
| style="background:#F5F5F5;" align="left" + |Tumor > 4 cm or minor bone erosion or perineural invasion or deep invasion
| bgcolor="Beige" | > 2mm thickness
|-
|-
| bgcolor="Beige" | Clark Level >= IV
| style="background:#DCDCDC;" align="left" + |T4
| style="background:#F5F5F5;" align="left" + |Tumor with gross cortical bone/marrow, skull base invasion and/or skull base foramen invasion
|-
|-
| bgcolor="Beige" | Perineural Invasion
| style="background:#DCDCDC;" align="center" + |T4a
| style="background:#F5F5F5;" align="left" + |Tumor with gross cortical bone/marrow invasion
|-
|-
|}
| style="background:#DCDCDC;" align="center" + |T4b
 
| style="background:#F5F5F5;" align="left" + |Tumor with skull base invasion and/or skull base foramen involvement
{| style="width:80%; height:100px" border="1"
| style="width:25%" ; border="1" | '''Regional Lymph Nodes(N)'''
|-
|-
|- bgcolor="LightSteelBlue"
| colspan="2" style="background:#A9A9A9;" align="left" + |N - Regional lymph nodes
|  <center> '''NX''' </center>
| bgcolor="Beige" |  Regional  lymph nodes cannot be assessed.
|-
|- bgcolor="LightSteelBlue"
|  <center> '''N0''' </center>
| bgcolor="Beige" | No regional lymph node metastases.
|-
|- bgcolor="LightSteelBlue"
|  <center> '''N1''' </center>
| bgcolor="Beige" | Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimesion.
|-
|- bgcolor="LightSteelBlue"
| <center>  '''N2''' </center>
| bgcolor="Beige" | Metastasis is single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension; or in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension; or in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimesnion. 
|-
|- bgcolor="LightSteelBlue"
|  <center> '''N2a''' </center>
| bgcolor="Beige" | Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension.
|-
|- bgcolor="LightSteelBlue"
|  <center> '''N2b''' </center>
| bgcolor="Beige" |  Metastasis in multiple ipsilateral lymph nodes, more than 6 cm in greatest dimension.
|-
|- bgcolor="LightSteelBlue"
|  <center> '''N2c''' </center>
| bgcolor="Beige" | Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension.
|- 
|- bgcolor="LightSteelBlue"
|  <center> '''N3''' </center>
| bgcolor="Beige" |Metastasis in a lymph node, more than 6 cm in greatest dimension.
|-
|}
 
{| style="width:35%; height:100px" border="1" 
| style="width:25%" ; border="1" | '''Metastasis (M)'''
|-
|- bgcolor="LightSteelBlue"
|  <center>  '''M0'''  </center>
| bgcolor="Beige" |  <center>  No distant Metastasis </center>
|-
|- bgcolor="LightSteelBlue"
| <center> '''M1''' </center>
| bgcolor="Beige" | <center> Distant Metastasis </center>
|-
|}
 
{| border="1" cellpadding="4" 
|+ '''Cutaneous Squamous cell carcinoma'''
! Grouping !! TNM staging
|-
|-
| Stage 0
| style="background:#DCDCDC;" align="left" + |NX
| Tis N0 M0
| style="background:#F5F5F5;" align="left" + |Regional lymph nodes cannot be assessed
|-
|-
| Stage I
| style="background:#DCDCDC;" align="left" + |N0
| T1 N0 M0
| style="background:#F5F5F5;" align="left" + |No regional lymph node metastasis
|-
|-
| Stage II
| style="background:#DCDCDC;" align="left" + |N1
| T2 N0 M0
| style="background:#F5F5F5;" align="left" + |Metastasis in a single ipsilateral lymph node, tumor size ≤ 3 cm, and no extranodal extension
|-
|-
| rowspan="4" | Stage III
| style="background:#DCDCDC;" align="left" + |N2
| T3 N0 M0
| style="background:#F5F5F5;" align="left" + |
* Metastasis in a single ipsilateral lymph node, tumor size ≤ 3 cm, and presence of extranodal extension; or
* Tumor size > 3 cm but ≤ 6 cm without extranodal extension; or
* Metastasis in a single ipsilateral lymph node, tumor size ≤ 3 cm, and presence of extranodal extension; or
* Metastases in multiple ipsilateral lymph nodes, tumor size ≤ 6 cm without extranodal extension; or
* In bilateral or contralateral lymph node(s), tumor size ≤ 6 cm without extranodal extension
|-
|-
| T1 N1 M0
| style="background:#DCDCDC;" align="center" + |N2a
| style="background:#F5F5F5;" align="left" + |
* Metastasis in a single ipsilateral lymph node, tumor size ≤ 3 cm, and presence of extranodal involvement; or
* Single ipsilateral node larger, tumor size > 3 cm and ≤ 6 cm, without extranodal extension
|-
|-
| T2 N1 M0
| style="background:#DCDCDC;" align="center" + |N2b
| style="background:#F5F5F5;" align="left" + |Metastases in multiple ipsilateral nodes, tumor size ≤ 6 cm, and without extranodal extension
|-
|-
| T3 N1 M0
| style="background:#DCDCDC;" align="center" + |N2c
| style="background:#F5F5F5;" align="left" + |Metastases in bilateral or contralateral lymph node(s), tumor size ≤ 6 cm, and without extranodal extension
|-
|-
| rowspan="6" | Stage IV
| style="background:#DCDCDC;" align="left" + |N3
| T1 N2 M0
| style="background:#F5F5F5;" align="left" + |
* Metastasis in a lymph node, tumor size > 6 cm, and without extranodal extension; or
* In a single ipsilateral node, tumor size > 3 cm, and presence of extranodal extension; or
* Multiple ipsilateral, contralateral, or bilateral nodes with any extranodal exension; or
* Single contralateral node of any size with any extranodal extension
|-
|-
| T2 N2 M0
| style="background:#DCDCDC;" align="center" + |N3a
| style="background:#F5F5F5;" align="left" + |Metastasis in a lymph node, tumor size > 6 cm, and absence of extranodal extension
|-
|-
| T3 N2 M0
| style="background:#DCDCDC;" align="center" + |N3b
| style="background:#F5F5F5;" align="left" + |
* Metastasis in a single ipsilateral node, tumor size > 3 cm, and in presence of extranodal extension; or
* Multiple ipsilateral, contralateral, or bilateral nodes, with any extranodal extension; or
* Single contralateral node of any size and with any extranodal extension
|-
|-
| Any T N3 M0
| colspan="2" style="background:#A9A9A9;" align="left" + |M - Distant metastasis
|-
|-
| T4 Any N M0
| style="background:#DCDCDC;" align="left" + |M0
| style="background:#F5F5F5;" align="left" + |No distant metastasis
|-
|-
| Any T Any N M1
| style="background:#DCDCDC;" align="left" + |M1
| style="background:#F5F5F5;" align="left" + |Distant metastasis
|}
|}


Latest revision as of 00:04, 11 June 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Roukoz A. Karam, M.D.[2]

Overview

Classification

Category Criteria
T - Primary tumor
TX Primary tumor cannot be assessed
Tis Carcinoma in situ
T1 Tumor ≤ to 2 cm
T2 Tumor > 2 cm, and ≤ to 4 cm
T3 Tumor > 4 cm or minor bone erosion or perineural invasion or deep invasion
T4 Tumor with gross cortical bone/marrow, skull base invasion and/or skull base foramen invasion
T4a Tumor with gross cortical bone/marrow invasion
T4b Tumor with skull base invasion and/or skull base foramen involvement
N - Regional lymph nodes
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in a single ipsilateral lymph node, tumor size ≤ 3 cm, and no extranodal extension
N2
  • Metastasis in a single ipsilateral lymph node, tumor size ≤ 3 cm, and presence of extranodal extension; or
  • Tumor size > 3 cm but ≤ 6 cm without extranodal extension; or
  • Metastasis in a single ipsilateral lymph node, tumor size ≤ 3 cm, and presence of extranodal extension; or
  • Metastases in multiple ipsilateral lymph nodes, tumor size ≤ 6 cm without extranodal extension; or
  • In bilateral or contralateral lymph node(s), tumor size ≤ 6 cm without extranodal extension
N2a
  • Metastasis in a single ipsilateral lymph node, tumor size ≤ 3 cm, and presence of extranodal involvement; or
  • Single ipsilateral node larger, tumor size > 3 cm and ≤ 6 cm, without extranodal extension
N2b Metastases in multiple ipsilateral nodes, tumor size ≤ 6 cm, and without extranodal extension
N2c Metastases in bilateral or contralateral lymph node(s), tumor size ≤ 6 cm, and without extranodal extension
N3
  • Metastasis in a lymph node, tumor size > 6 cm, and without extranodal extension; or
  • In a single ipsilateral node, tumor size > 3 cm, and presence of extranodal extension; or
  • Multiple ipsilateral, contralateral, or bilateral nodes with any extranodal exension; or
  • Single contralateral node of any size with any extranodal extension
N3a Metastasis in a lymph node, tumor size > 6 cm, and absence of extranodal extension
N3b
  • Metastasis in a single ipsilateral node, tumor size > 3 cm, and in presence of extranodal extension; or
  • Multiple ipsilateral, contralateral, or bilateral nodes, with any extranodal extension; or
  • Single contralateral node of any size and with any extranodal extension
M - Distant metastasis
M0 No distant metastasis
M1 Distant metastasis

References


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