Carcinoma of Skin (excluding eyelid, head and neck, perianal, vulva, and penis)
133
Carcinoma of Skin (excluding eyelid, head and neck, perianal, vulva, and penis) (ICD‐O‐3 C44.5‐7, C63.2)*
The classification applies only to carcinomas, excluding Merkel cell carcinoma. There should be histological confirmation of the disease and division of cases by histological type. The following are the procedures for assessing T, N, and M categories: T categories Physical examination N categories Physical examination and imaging M categories Physical examination and imaging Note * The AJCC only includes the classification for skin carcinoma of the head and neck.
Regional Lymph Nodes The regional lymph nodes are those appropriate to the site of the primary tumour. See page 132.
TNM Clinical Classification T – Primary Tumour TX T0 Tis
Primary tumour cannot be identified No evidence of primary tumour Carcinoma in situ
T1 Tumour 2 cm or less in greatest dimension T2 Tumour >2 cm and ≤4 cm in greatest dimension T3 Tumour >4 cm in greatest dimension or minor bone erosion or perineural invasion or deep invasion* T4a Tumour with gross cortical bone/marrow invasion T4b Tumour with axial skeleton invasion including foraminal involve ment and/or vertebral foramen involvement to the epidural space Note * Deep invasion is defined as invasion beyond the subcutaneous fat or >6 mm (as meas ured from the granular layer of adjacent normal epidermis to the base of the tumour);
Skin
Rules for Classification*
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Skin Tumours
perineural invasion for T3 classification is defined as clinical or radiographic involvement of named nerves without foramen or skull base invasion or transgression. In the case of multiple simultaneous tumours, the tumour with the highest T cate gory is classified and the number of separate tumours is indicated in parentheses, e.g., T2(5).
N – Regional Lymph Nodes NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 Metastasis in a single 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 nodes none more than 6 cm in greatest dimension N3 Metastasis in a lymph node more than 6 cm in greatest dimension
M – Distant Metastasis M0 No distant metastasis M1 Distant metastatic disease* Note * Contralateral nodes in non‐melanoma non‐head and neck cancer are distant metastases.
pTNM Pathological Classification The pT and pN categories correspond to the T and N categories. For pM see page 8. pN0 Histological examination of a regional lymphadenectomy specimen will ordinarily include 6 or more lymph nodes. If the lymph nodes are negative, but the number ordinarily examined is not met, classify as pN0.
Stage Stage 0 Stage I Stage II Stage III
Tis T1 T2 T3 T1, T2, T3
N0 N0 N0 N0 N1
M0 M0 M0 M0 M0
Carcinoma of Skin (excluding eyelid, head and neck, perianal, vulva, and penis)
Stage IVA Stage IVB
T1, T2, T3 T4 Any T
N2, N3 Any N Any N
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M0 M0 M1
Prognostic Factors Grid – Non‐Melanoma Skin
Prognostic factors
Tumour related
Host related
Environment related
Essential
TNM Histopathological type Location Thickness PNI (clinical)
Immune suppression Recurrent disease
Surgical margins Previous RT
Additional
Tumour borders Differentiation Rate of growth LVSI PNI (incidental)
Genetic factors Gorlin syndrome Age Chronic inflammation, scars, burns
Smoking (SCC)
New and promising
SLNB Perturbed cellular pathways
Viral aetiology Highly conformal RT Chemoradiotherapy Targeted therapies Intralesional therapy
Source: UICC Manual of Clinical Oncology, Ninth Edition. Edited by Brian O’Sullivan, James D. Brierley, Anil K. D’Cruz, Martin F. Fey, Raphael Pollock, Jan B. Vermorken and Shao Hui Huang. © 2015 UICC. Published 2015 by John Wiley & Sons, Ltd.
Skin
Tumour‐, host‐ and environment‐related prognostic factors for skin cancer