Cutaneous carcinoma of the head and neck (staging)

Last revised by Francis Deng on 1 Apr 2019

Cutaneous carcinoma of the head and neck staging refers to TNM staging of nonmelanoma skin cancer involving the scalp, external ear, neck, or face including external lips. The system applies to cutaneous squamous cell carcinoma and numerous other skin carcinomas, notably excluding eyelid carcinomacutaneous melanoma, and Merkel cell carcinoma, which are staged in separate TNM systems. There is no TNM system for cutaneous squamous cell carcinoma outside the head and neck. The following article reflects the 8th edition manual published by the American Joint Committee on Cancer (AJCC), which is used for staging starting January 1, 2018 1,2.

  • TX: primary tumor cannot be assessed
  • Tis: carcinoma in situ
  • T1: tumor ≤2 cm in greatest dimension
  • T2: tumor >2 cm and ≤4 cm
  • T3: any of the following:
    • tumor >4 cm
    • minor bone erosion
    • perineural invasion, defined as either of the following:
      • clinical or radiographic involvement of named nerves without skull base invasion or transgression, or
      • tumor infiltration of the sheath of a nerve deeper than the dermis or measuring ≥0.1 mm in caliber
    • deep invasion, defined as either of the following:
      • invasion beyond the subcutaneous fat, or
      • invasion >6 mm from granular layer of adjacent epidermis to base of tumor
  • T4
    • T4a: gross cortical bone/marrow invasion
    • T4b: skull base invasion and/or involvement of skull base foramen

Regional nodal status is defined the same as for most other cancers of the head and neck. See the main article, cervical lymph node (staging).

The terms pM0 and MX are not valid TNM categories. The following categories may be used:

  • cM0: no evidence of metastases
  • cM1: distant metastasis
  • pM1: distant metastasis, microscopically confirmed
  • stage 0
    • Tis, N0, M0
  • stage I
    • T1, N0, M0
  • stage II
    • T2, N0, M0
  • stage III
    • T3, N0, M0
    • [T1, T2, T3], N1, M0
  • stage IV
    • T4, [Any N], [Any M]
    • [Any T], [N2, N3], [Any M]
    • [Any T], [Any N], M1

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