Skin Cancer

Skin Cancers

Staging

Skin cancers are classified and staged according to the tumor, node and metastasis (TNM) system developed by the American Joint Committee on Cancer (AJCC). Doctors categorize the tumor (T) according to its size and location, whether cancer cells are found in nearby lymph nodes (N) and whether the cancer has metastasized (M), or spread, to other parts of the body. CSCC is also classified by grades, which are different from the stages used to classify most other cancers. Tumor grades are based on how closely the cells resemble normal, healthy cells when viewed under a microscope. The pathologist will examine cells through a microscope and then assign a number to the grade according to how different these cells are from normal tissue cells.

AJCC TNM System for Classifying Non-Melanoma Skin Cancer

Classification Definition
Tumor (T)
Tx Primary tumor cannot be assessed.
Tis Carcinoma in situ.
T1 Tumor smaller than 2 cm in greatest dimension.
T2 Tumor 2 cm or larger, but smaller than 4 cm in greatest dimension.
T3 Tumor 4 cm or larger in maximum dimension or minor bone erosion or perineural invasion or deep invasion.
T4 Tumor with gross cortical bone/marrow, 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.
Node (N)
Nx Regional lymph nodes cannot be assessed.
N0 No regional lymph node metastasis.
N1 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 (on the same side of the body) lymph nodes, none larger than 6 cm in greatest dimension and ENE(–);
or in bilateral (on both sides of the body) or contralateral (on the opposite side of the body) lymph node(s), none larger than 6 cm in greatest dimension, ENE(–).
N2a Metastasis in single ipsilateral (on the same side of the body) 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(–).
N2b Metastasis in multiple ipsilateral (on the same side of the body) nodes, none larger than 6 cm in greatest dimension and ENE**(–).
N2c Metastasis in bilateral (on both sides of the body) or contralateral (on the opposite side of the body) lymph node(s), none larger than 6 cm in greatest dimension and ENE(–).
N3
Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE**(–);
or in a single ipsilateral (on the same side of the body) node larger than 3 cm in greatest dimension and ENE(+);
or multiple ipsilateral, contralateral (on the opposite side of the body), or bilateral (on both sides of the body) nodes, any with ENE(+);
or a single contralateral (on the opposite side of the body) node 3 cm or smaller and ENE(+).
N3a Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE**(–).
N3b Metastasis in a single ipsilateral (on the same side of the body) node larger than 3 cm in greatest dimension and ENE**(+);
or multiple ipsilateral, contralateral (on the opposite side of the body), or bilateral (on both sides of the body) nodes, any with ENE(+);
or a single contralateral (on the opposite side of the body) node 3 cm or smaller 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).
**Extranodal extension (ENE) refers to cancer cells that have spread through the node into surrounding connective tissue.
Metastasis (M)
M0 No distant metastasis.
M1 Distant metastasis.
Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer Science+Business Media.

Stages of Non-Melanoma Skin Cancer

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

Stages of Non-Melanoma Skin Cancer

Classification Definition
GX Grade cannot be assessed.
G1 Well differentiated.
G2 Moderately differentiated.
G3 Poorly differentiated.
G4 Undifferentiated.

Illustrated Stages of Non-Melanoma Skin Cancer

A cluster of malignant cells, also called carcinoma in situ, that has not spread deeper into the tissue or elsewhere.
The tumor is less than 2 cm in greatest dimension.
The tumor is more than 2 cm but not more than 4 cm in greatest dimension.
The tumor is less than 2 cm in greatest dimension or is more than 2 cm but not more than 4 cm in greatest dimension, and has spread to a single lymph node on the same side of the body. Or, the tumor is more than 4 cm in greatest dimension or minor bone erosion, perineural invasion or deep invasion, and may have spread to a single lymph node on the same side of the body.

The tumor may be any size, may have spread to one or more lymph nodes on the same side of the body as the tumor, the opposite side of the body as the tumor or on both sides of the body; and may have spread to distant parts of the body.

 

AJCC TNM System for Classifying Merkel Cell Carcinoma (MCC)

Classification Definition
Tumor (T)
Tx Primary tumor cannot be assessed (e.g., curetted).
T0 No evidence of primary tumor.
Tis In situ primary tumor.
T1 Maximum clinical tumor diameter < 2 cm (or less).
T2 Maximum clinical tumor diameter > (more than) 2 cm but ≯ (not more than) 5 cm.
T3 Maximum clinical tumor diameter > (more than) 5 cm.
T4 Primary tumor invades fascia, muscle, cartilage, or bone.
Node (N)
Nx Regional lymph nodes cannot be assessed.
N0 No regional lymph node metastasis detected on pathological evaluation.
N1 Metastasis in regional lymph node(s).
N1a(sn) Clinically occult regional lymph node metastasis identified only by sentinel lymph node biopsy.
N1a Clinically occult regional lymph node metastasis following lymph node dissection.
N1b Clinically and/or radiologically detected regional lymph node metastasis, microscopically confirmed.
N2 In-transit metastasis (discontinuous from primary tumor; located between primary tumor and draining regional nodal basin, or distal to the primary tumor) without lymph node metastasis.
N3 In-transit metastasis (discontinuous from primary tumor; located between primary tumor and draining regional nodal basin, or distal to the primary tumor) with lymph node metastasis.
Metastasis (M)
M0 No distant metastasis detected on clinical and/or radiologic examination.
M1 Distant metastasis microscopically confirmed.
M1a Metastasis to distant skin, distant subcutaneous tissue, or distant lymph node(s), microscopically confirmed.
M1b Metastasis to lung, microscopically confirmed.
M1c Metastasis to all other distant sites, microscopically confirmed.

Stages of Merkel Cell Carcinoma (MCC)

Stage T N M
0 Tis N0 M0
I T1 N0 M0
IIA T2-3 N0  
IIB T4 N0 M0
IIIA T1-4
T0 		N1a(sn) or
N1a
N1b 		M0
M0
IIIB T1-4 N1b-3 M0
IV T0-4 Any N M1
Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer Science+Business Media.

Illustrated Stages of Merkel Cell Carcinoma (MCC)

A cluster of malignant cells, also called carcinoma in situ, that has not spread deeper into the tissue or elsewhere.
The tumor is less than 2 cm in greatest dimension.
The tumor is more than 2 cm but not more than 5 cm in greatest dimension or is more than 5 cm in greatest dimension.
The tumor is any size and has spread to the fascia, muscle, cartilage or bone.
The tumor may be any size and isolated cancer cells are detected in regional lymph nodes after either a sentinel lymph node biopsy or lymph node dissection. Or, there is no evidence of a primary tumor but cancer cells are microscopically detected in nearby lymph nodes.
The tumor may be any size and may have spread to regional lymph nodes.
The tumor may be any size, may have spread to nearby lymph nodes and has spread to distant skin, tissue or lymph nodes, or to the lung or to other distant parts of the body.
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