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

#Arrangoiz #HeadandNeckSurgeon #CancerSurgeon #SurgicalOncologist #SkinCancer

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