Skin - Nonmelanocytic tumors
Carcinoma (non-adnexal)
Staging of skin carcinomas

Author: Ghassan Tranesh, M.D. (see Authors page)
Editor: Hong Qu, M.D.

Revised: 13 October 2016, last major update December 2014

Copyright: (c) 2002-2016, PathologyOutlines.com, Inc.

PubMed Search: Staging [title] skin carcinomas

Cite this page: Staging of skin carcinomas. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/skintumornonmelanocyticstagingskincarcinoma.html. Accessed December 6th, 2016.
Definition / General
  • Staging of melanomas is described in Skin-Melanocytic tumors chapter
  • Staging of related eye tumors is described in the Eye chapter for Conjunctiva, Eyelid, Lacrimal gland
  • Includes spindle cell variant of squamous cell carcinoma and adnexal carcinomas
  • Applies to clinical and pathologic staging

TNM descriptors
  • Required only if applicable
    • m (multiple)
    • r (recurrent)
    • y (posttreatment)

Primary tumor (T)
  • TX: Primary tumor cannot be assessed
  • T0: No evidence of primary tumor
  • Tis: Carcinoma in situ
  • T1: Tumor 2 cm or less in greatest dimension with less than 2 high risk features
  • T2: Tumor more than 2 cm in greatest dimension with or without one additional high risk features, or any size with two or more high risk features.
  • T3: Tumor with invasion of maxilla, mandible, orbit, or temporal bone.
  • T4: Tumor invades skeleton (axial or appendicular) or perineural invasion of skull base

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 dimension
  • N2: Metastasis in a 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 dimension
  • 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, none 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

Distant metastasis (M)
  • Not applicable
  • M0: No distant metastasis
  • M1: Distant metastasis, specifiy sites if known

Stage grouping
  • Stage 0: Tis N0 M0
  • Stage I: T1 N0 M0
  • Stage II: T2 N0 M0
  • Stage III: T3 N0 M0 or T1-3 N1 M0
  • Stage IV: T1-3 N2 M0 or any T N3 M0 or T4 any N M0 or any T any N M1

Notes
  • Patients with primary clinical squamous cell carcinoma or other cutaneous carcinomas with no evidence (clinical, radiologic or pathologic) of regional or distant metastases are divided into two stages:
    • Stage I for tumors measuring 2 cm or less in size
    • Stage II for those that are greater than 2 cm in size
  • If there is clinical concern for extension of tumor into bone and radiologic evaluation is negative, these data may be included to support the Stage I vs. II designation
  • Tumors that are 2 cm or less in size can be upstaged to Stage II if they contain two or more high-risk features
  • Stage III patients are those with:
    • Clinical, histologic or radiologic evidence of one solitary node measuring 3 cm or less in size or
    • Tumor extension into bone: maxilla, mandible, orbit or temporal bone
  • Stage IV patients are those with:
    • Tumor with direct or perineural invasion of skull base or axial skeleton
    • 2 or more involved lymph nodes or
    • Single or multiple involved lymph nodes measuring > 3 cm in size or
    • Distant metastasis
Additional References