American Joint Committee on Cancer TNM staging system for cutaneous squamous cell carcinoma

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 two high-risk features (see list of high-risk features below)
T2	Tumor greater than 2 cm in greatest dimension OR
	Tumor any size with two or more high-risk features
T3	Tumor with invasion of maxilla, mandible, orbit, or temporal bone
T4	Tumor with invasion of skeleton (axial or appendicular) or perineural invasion of skull base
High-risk features for the primary tumor (T) staging
Depth/invasion	>2 mm thickness
	Clark level ≥IV
	Perineural invasion
Anatomic location	Primary site ear
	Primary site hair-bearing lip
Differentiation	Poorly differentiated or undifferentiated
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)
M0	No distant metastases
MI	Distant metastases
Anatomic stage/prognostic groups^¶
Stage 0	Tis	N0	M0
Stage I	T1	N0	M0
Stage II	T2	N0	M0
Stage III	T3	N0	M0
	T1	N1	M0
	T2	N1	M0
	T3	N1	M0
Stage IV	T1	N2	M0
	T2	N2	M0
	T3	N2	M0
	Any T	N3	M0
	T4	Any N	M0
	Any T	Any N	M1

Note: cTNM is the clinical classification, pTNM is the pathologic classification.

cSCC: cutaneous squamous cell carcinoma.
* Excludes cSCC of the eyelid.
¶ Patients with primary cSCC 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 in size and Stage II for those that are greater than 2 cm in size. In instances where there is clinical concern for extension of tumor into bone and radiologic evaluation has been performed (and is negative), these data may be included to support the Stage I versus II designation. Tumors that are ≤2 cm in size can be upstaged to Stage II if they contain two or more high-risk features. Stage III patients are those with (1) clinical, histologic, or radiologic evidence of one solitary node measuring ≤3 cm in size or (2) tumor extension into bone: maxilla, mandible, orbit, or temporal bone. Stage IV patients are those with (1) tumor with direct or perineural invasion of skull base or axial skeleton, (2) ≥2 lymph nodes or (3) single or multiple lymph nodes measuring >3 cm in size or (4) distant metastasis.

Used with the permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010) published by Springer New York, Inc.

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American Joint Committee on Cancer TNM staging system for cutaneous squamous cell carcinoma