Squamous cell carcinoma of the skin classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2], Raviteja Guddeti, M.B.B.S. [3]

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

Primary Tumour(T)
TX	Primary tumour cannot be assessed.
T0	No evidence of primary tumour.
Tis	Carcinoma in situ.
T1	Tumour 2 cms or less in greatest dimension.
T2	Tumour greater than 2 cms in greatest dimesion.
	Or.
	Tumour any size with >= with high risk features ^^.
T3	Tumour with invasion of maxilla, mandible, orbit or temporal bone.
T4	Tumour with invasion of skelton(axial or appendicular) or perineural invasion of skull base

^{^^}High risk features are as follows.

High Risk Features For Primary Tumour(T) staging
Depth/Invasion	> 2mm thickness
	Clark Level >= IV
	Perineural Invasion

Regional Lymph Nodes(N)
NX	Regional lymph nodes cannot be assessed.
N0	No regional lymph node metastases.
N1	Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimesion.
N2	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.
N2a	Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension.
N2b	Metastasis in multiple ipsilateral lymph nodes, more than 6 cm in greatest dimension.
N2c	Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension.
N3	Metastasis in a lymph node, more than 6 cm in greatest dimension.

Metastasis (M)
M0	No distant Metastasis
M1	Distant Metastasis

Cutaneous Squamous cell carcinoma

Grouping	TNM staging
Stage 0	Tis N0 M0
Stage I	T1 N0 M0
Stage II	T2 N0 M0
Stage III	T3 N0 M0
	T1 N1 M0
	T2 N1 M0
	T3 N1 M0
Stage IV	T1 N2 M0
	T2 N2 M0
	T3 N2 M0
	Any T N3 M0
	T4 Any N M0
	Any T Any N M1

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