Cutaneous Carcinoma of the Head and Neck Staging 

Updated: Aug 15, 2018
  • Author: Marvaretta M Stevenson, MD; Chief Editor: Guy J Petruzzelli, MD, PhD, MBA, FACS  more...
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TNM Classification

The American Joint Committee on Cancer (AJCC) tumor/node/metastasis (TNM) classification for cutaneous carcinoma of the head and neck, prognostic staging groups, and histologic grades, are provided below. [1]

Table 1. TNM classification (Open Table in a new window)

Primary tumor (T)

TX

Primary tumor cannot be assessed

Tis

Carcinoma in situ

T1

Tumor smaller than or equal to 2 cm in greatest dimension

T2

Tumor > 2 cm but smaller than or equal to 4 cm in greatest dimension

T3

Tumor > 4 cm 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

* Deep invasion is defined as invasion beyond the subcutaneous fat or > 6 cm (as measured from the granular layer of adjacent normal epidermis to the base of the tumor); perineural invasion for T3 classification is defined as tumor cells within the nerve sheath of a nerve lying deeper than the dermis or measuring 0.1 mm or larger in caliber, or presenting with clinical or radiographic involvement of named nerves without skull base invasion or transgression.

Regional Lymph Nodes (N)
  Clinical N (cN)
NX Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Metastasis in a single ipsilateral lymph node ≤ 3 cm in greatest dimension and no extranodal extension (ENE [-])

N2

Metastasis in a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension and ENE (-);

or metastases in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-);

or in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)

N2a

Metastasis in a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension and ENE (-)

N2b

Metastasis in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)

N2c

Metastasis in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)

N3

Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-); or metastasis in any node(s) with clinically overt ENE (+)

N3a Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-)
N3b Metastasis in any node(s) with clinically overt ENE (+)
  Pathological N (pN)
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in a single ipsilateral lymph node ≤ 3 cm in greatest dimension and ENE (-)
N2

Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE (+);

or  a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension and ENE (-);

or metastases in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-);

or in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)
N2a

Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE (+);

or  a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension and ENE (-)
N2b Metastasis in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)
N2c Metastasis in bilateral or contralateral lymph node(s), none > 6 cm in greatest dimension and ENE (-)
N3

Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-);

or in a single ipsilateral node > 3 cm in greatest dimension and ENE (+);

or multiple ipsilateral, contralateral, or bilateral nodes, any with ENE (+);

or a single contralateral node of any size and ENE (+)
N3a Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-)
N3b

Metastasis in a single ipsilateral node > 3 cm in greatest dimension and ENE (+);

or multiple ipsilateral, contralateral, or bilateral nodes, any with ENE (+);

or a single contralateral node of any size and ENE (+)

Distant metastasis (M)

cM0

No distant metastasis

cM1

Distant metastasis

pM1 Distant metastasis, microscopically confirmed

      Table 2. Prognostic staging groups (Open Table in a new window)

Stage

T

N

M

0

Tis

N0

M0

I

T1

N0

M0

II

T2

N0

M0

III

T3

N0

M0

T1–T3

N1

M0

IV

 

T1–T3

N2

M0

T Any

N3

M0

T4

N Any

M0

T Any

N Any

M1

      Table 3. Histologic grade (Open Table in a new window)

Histologic grade (G)

GX

Grade cannot be assessed

G1

Well differentiated

G2

Moderately differentiated

G3

Poorly differentiated

G4

Undifferentiated