Cutaneous Carcinoma of the Head and Neck Staging
Updated: Aug 20, 2021
Author: Marvaretta M Stevenson, MD; Chief Editor: Guy J Petruzzelli, MD, PhD, MBA, FACS
The American Joint Committee on Cancer (AJCC) tumor/node/metastasis (TNM) classification, prognostic staging groups, and histologic grades for cutaneous carcinoma of the head and neck 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 |