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Stage Information for Skin Cancer

    There are separate staging systems in the 7th edition of the American Joint Committee on Cancer's (AJCC) AJCC Cancer Staging Manual for carcinomas of the eyelid versus other skin surfaces.[1,2] The staging system for non-eyelid skin cancers is primarily designed for squamous cell carcinomas (SCCs). The staging system for carcinoma of the eyelid addresses carcinomas of all histologies.

    Basal cell carcinoma (BCC) rarely metastasizes, thus, a metastatic work-up is usually not necessary. Regional lymph nodes should be routinely examined in all cases of SCC, especially for high-risk tumors appearing on the lips, ears, perianal and perigenital regions, or high-risk areas of the hand. In addition, regional lymph nodes should be examined with particular care in cases of SCCs arising in sites of chronic ulceration or inflammation, burn scars, or sites of previous radiation therapy treatment.

    Table 2 has a separate list of risk features that should be evaluated for non-eyelid carcinomas; the relevant risk features should also be evaluated for SCCs of the eyelid. Even with relatively small tumor size, SCCs that occur in immunosuppressed patients tend to have more aggressive behavior than SCCs in nonimmunosuppressed patients. Although not a formal part of the AJCC staging system, it is recommended that centers prospectively studying SCC record the presence and type of immunosuppression in addition to the risk features listed in Table 2.

    Staging for Cutaneous SCC and Other Cutaneous Carcinomas (Excluding Carcinoma of the Eyelid)

    The American Joint Committee on Cancer has designated staging by TNM classification.[1] The TNM classification is used to stage both BCC and SCC.

    Table 1. Primary Tumor (T) for Non-Eyelid Carcinomaa,b

    a 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.
    b Excludes cutaneous squamous cell carcinoma of the eyelid.
    c High-risk features for the primary tumor (T) staging.
    TXPrimary tumor cannot be assessed.
    T0No evidence of primary tumor.
    TisCarcinoma in situ.
    T1Tumor ≤2 cm in greatest dimension with <2 high-risk features.c
    T2Tumor >2 cm in greatest dimension.
    Tumor any size with ≥2 high-risk features.c
    T3Tumor with invasion of maxilla, mandible, orbit, or temporal bone.
    T4Tumor with invasion of skeleton (axial or appendicular) or perineural invasion of skull base.

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