of Squamous Cell Carcinoma and Basal Cell Carcinoma

Primary tumor cannot be assessed

No evidence of primary tumor

Tis

Carcinoma in situ

Tumor ≤2 cm in greatest dimension with <2 high-risk features^b

Tumor >2 cm in greatest dimension or

Tumor any size with ≥2 high-risk features^b

Tumor with invasion of maxilla, mandible, orbit, or temporal bone

Tumor with invasion of skeleton (axial or appendicular) or perineural invasion of skull base

Reprinted with permission from AJCC: Cutaneous squamous cell carcinoma and other cutaneous carcinomas. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 301–14

^aExcludes cutaneous squamous cell carcinoma of the eyelid

^bHigh-risk features for the primary tumor (T) staging

Table 2

High-risk features for primary tumor (T) staging for cutaneous non-eyelid carcinoma

Depth/invasion	>2 mm thickness (Breslow thickness)
	Clark level ≥IV
	Perineural invasion
Anatomic location	Primary site ear
	Primary site non-hair-bearing lip
Differentiation	Poorly differentiated or undifferentiated

Table 3

Regional lymph nodes (N) for cutaneous carcinoma

NX	Regional lymph nodes cannot be assessed
N0	No regional lymph node metastases
N1	Metastasis in a single ipsilateral lymph node, ≤3 cm in greatest dimension
N2	Metastasis in a single ipsilateral lymph node, >3 cm but ≤6 cm in greatest dimension; or in multiple ipsilateral lymph nodes, ≤6 cm in greatest dimension; or in bilateral or contralateral lymph nodes, ≤6 cm in greatest dimension
N2a	Metastasis in a single ipsilateral lymph node, >3 cm but ≤6 cm in greatest dimension
N2b	Metastases in multiple ipsilateral lymph nodes, ≤6 cm in greatest dimension
N2c	Metastases in bilateral or contralateral lymph nodes, ≤6 cm in greatest dimension
N3	Metastasis in a lymph node, >6 cm in greatest dimension

Table 4

Anatomic stage/prognostic groups for cutaneous carcinoma

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

Table 5

Primary tumor (T) for eyelid carcinoma

TX	Primary tumor cannot be assessed
T0	No evidence of primary tumor
Tis	Carcinoma in situ
TX	Primary tumor cannot be assessed
T1	Tumor ≤5 mm in greatest dimension
	Not invading the tarsal plate or eyelid margin
T2a	Tumor >5 mm but not >10 mm in greatest dimension
	Or, any tumor that invades the tarsal plate or eyelid margin
T2b	Tumor >10 mm but not >20 mm in greatest dimension
	Or, involves full thickness eyelid
T3a	Tumor >20 mm in greatest dimension
	Or, any tumor that invades adjacent ocular or orbital structures
	Any T with perineural tumor invasion
T3b	Complete tumor resection requires enucleation, exenteration, or bone resection
T4	Tumor is not resectable because of extensive invasion of ocular, orbital, craniofacial structures, or brain

Reprinted with permission from AJCC: Carcinoma of the Eyelid. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 523–526

Table 6

Regional lymph nodes (N) for eyelid carcinoma

NX	Regional lymph nodes cannot be assessed
cN0	No regional lymph node metastasis based upon clinical evaluation or imaging
pN0	No regional lymph node metastasis based upon lymph node biopsy
N1	Regional lymph node metastasis

Reprinted with permission from AJCC: Carcinoma of the Eyelid. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 523–526

Table 7

Anatomic stage/prognostic groups for eyelid carcinoma

Stage 0	Tis	N0	M0
Stage IA	T1	N0	M0
Stage IB	T2a	N0	M0
Stage IC	T2b	N0	M0
Stage II	T3a	N0	M0
Stage IIIA	T3b	N0	M0
Stage IIIB	Any T	N1	M0
Stage IIIC	T4	Any N	M0
Stage IV	Any T	Any N	M1

Reprinted with permission from AJCC: Carcinoma of the Eyelid. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 523–526

In general, radial size for both SCC and BCC is thought to mirror biologic behavior. Overall staging is based on radial size (stage I <2 cm and stage II >2 cm). As the carcinomas extend vertically, with invasion into deeper tissue such as bone and beyond to lymph nodes, they receive a higher overall stage (III–IV). Based solely on T (tumor) component of the TNM classification system, invasion into the maxilla, mandible, orbit, or temporal bone automatically receives an overall stage III (T3 N0 M0) and direct or perineural invasion into the skull base or axial skeleton receives an overall stage IV (T4 N0 M0). Similarly, based solely on N (nodal involvement) of the TNM classification system, involvement of a single ipsilateral node ≤3 cm in size receives an overall stage III and involvement of nodes ≥3 cm in size or multiple nodes receives an overall stage IV. Metastasis is categorized as either M0 (no metastasis) or M1 (distant metastasis, which if present, is assigned an overall stage IV) for SCC and BCC.

Staging for Squamous Cell Carcinoma Treated by Dermatologists Utilizing Radiotherapy

As mentioned previously, AJCC staging primarily applies to SCC as BCC has a different biological behavior and is limited mainly to local destruction with very little chance of distant metastasis (see Chaps. 7, 8 and 9

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