American Joint Committee on Cancer (AJCC) Staging of Cutaneous Squamous Cell Carcinoma of the Head and Neck

• Primary Tumor
  • TX – Primary tumor cannot be assessed
  • Tis – Carcinoma in situ
  • T1 – Tumor smaller than or equal to 2 cm in greatest dimension
  • T2 – Tumor larger than 2 cm, but smaller than or equal to 4 cm in greatest dimension
  • T3- Tumor larger than 4 cm in maximum dimension or minor bone erosion or perineural invasion or deep invasion*
  • T4 – Tumor with gross cortical bone / marrow, invasion, 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
      • *Deep invasion is defined as invasion beyond the subcutaneous fat or greater than 6 mm:
        • As measured from the granular layer of adjacent normal epidermis to the base of the tumor
      • *Perineural invasion for T3 classification is defined as:
        • Tumor cells within the nerve sheath of a nerve lying deeper than the dermis or
        • Measuring 0.1 mm or larger in caliber, or
        • Presenting with clinical or radiographic involvement of named nerves without skull base invasion or transgression

• Regional Lymph Nodes
  • cNX- Regional lymph nodes cannot be assessed
  • cN0 – No regional lymph node metastasis
  • cN1 – Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE(−)
  • cN2 – Metastasis in a single ipsilateral node larger than 3 cm but not larger than 6 cm in greatest dimension and ENE(−); or metastases in multiple ipsilateral lymph nodes, none larger than 6 cm in greatest dimension and ENE(−); or in bilateral or contralateral lymph nodes, none larger than 6 cm in greatest dimension and ENE(−)
    • cN2a – Metastasis in a single ipsilateral node larger than 3 cm but not larger than 6 cm in greatest dimension and ENE(−)
    • cN2b – Metastases in multiple ipsilateral nodes, none larger than 6 cm in greatest dimension and ENE(−)
    • cN2c – Metastases in bilateral or contralateral lymph nodes, none larger than 6 cm in greatest dimension and ENE(−)
  • cN3 – Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE(−); or metastasis in any node(s) and clinically overt ENE [ENE(+)]
    • cN3a – Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE(−)
    • cN3b – Metastasis in any node(s) and ENE (+)
      • Note:
        • A designation of “U” or “L” may be used for any N category:
          • To indicate metastasis above the lower border of the cricoid (U) or below the lower border of the cricoid (L)
          • Similarly, clinical and pathological extranodal extension (ENE):
            • Should be recorded as ENE(−) or ENE(+)

• pNX – Regional lymph nodes cannot be assessed
• pN0 – No regional lymph node metastasis
• pN1 – Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE(−)
• pN2 – Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE(+); or larger than 3 cm but not larger than 6 cm in greatest dimension and ENE(−); or metastases in multiple ipsilateral lymph nodes, none larger than 6 cm in greatest dimension and ENE(−); or in bilateral or contralateral lymph node(s), none larger than 6 cm in greatest dimension, ENE(−)
  • pN2a – Metastasis in single ipsilateral node 3 cm or smaller in greatest dimension and ENE(+); or a single ipsilateral node larger than 3 cm but not larger than 6 cm in greatest dimension and ENE(−)
  • pN2b – Metastases in multiple ipsilateral nodes, none larger than 6 cm in greatest dimension and ENE(−)
  • pN2c – Metastases in bilateral or contralateral lymph node(s), none larger than 6 cm in greatest dimension and ENE(−)
• pN3 – Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE(−); or in a single ipsilateral node larger than 3 cm in greatest dimension and ENE(+); or multiple ipsilateral, contralateral, or bilateral nodes, any with ENE(+); or a single contralateral node of any size and ENE(+)
  • pN3a – Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE(−)
  • pN3b – Metastasis in a single ipsilateral node larger than 3 cm in greatest dimension and ENE(+); or multiple ipsilateral, contralateral, or bilateral nodes, any with ENE(+); or a single contralateral node of any size and ENE(+)
    • Note:
      • A designation of “U” or “L” may be used for any N category to indicate metastasis above the lower border of the cricoid (U) or below the lower border of the cricoid (L)
      • Similarly, clinical and pathological extranodal extension (ENE) should be recorded as ENE(−) or ENE(+)

• Distant Metastasis
  • M0 – No distant metastasis
  • M1 – Distant metastasis
• G Histologic Grade
  • GX – Grade cannot be assessed
  • G1 – Well differentiated
  • G2 – Moderately differentiated
  • G3 – Poorly differentiated
  • G4 – Undifferentiated

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