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Journal of the American Academy of Dermatology

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A new American Joint Committee on Cancer staging system for cutaneous squamous cell carcinoma: Creation and rationale for inclusion of tumor (T) characteristics - 10/08/11

Doi : 10.1016/j.jaad.2010.08.033 
Sharifeh Farasat, BS a, Siegrid S. Yu, MD b, Victor A. Neel, MD, PhD c, Kishwer S. Nehal, MD d, Thomas Lardaro, BSc a, Martin C. Mihm, MD e, David R. Byrd, MD f, Charles M. Balch, MD g, h, i, Joseph A. Califano, MD j, Alice Y. Chuang, MD i, William H. Sharfman, MD h, i, Jatin P. Shah, MD, PhD k, Paul Nghiem, MD, PhD l, Clark C. Otley, MD m, Anthony P. Tufaro, DDS, MD n, Timothy M. Johnson, MD o, Arthur J. Sober, MD c, Nanette J. Liégeois, MD, PhD h, j, n, ⁎
a School of Medicine, Johns Hopkins University, Baltimore, Maryland 
g Department of Surgery, Johns Hopkins University, Baltimore, Maryland 
h Department of Oncology, Johns Hopkins University, Baltimore, Maryland 
i Department of Dermatology, Johns Hopkins University, Baltimore, Maryland 
j Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland 
n Department of Plastic Surgery, Johns Hopkins University, Baltimore, Maryland 
b Department of Dermatology, University of California, San Francisco, California 
c Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 
e Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 
d Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York 
k Department of Surgery, Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York 
f Department of Surgery, Division of Plastic Surgery, University of Washington, Seattle, Washington 
l Department of Medicine, Division of Dermatology, University of Washington, Seattle, Washington 
m Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota 
o Department of Dermatology, University of Michigan, Ann Arbor, Michigan 

Reprint requests: Nanette J. Liégeois, MD, PhD, University of Maryland, Department of Dermatology, 419 W Redwood St, Suite 240, Baltimore, MD 21201.

Abstract

Background

The incidence of cutaneous squamous cell carcinoma (cSCC) is increasing. Although most patients achieve complete remission with surgical treatment, those with advanced disease have a poor prognosis. The American Joint Committee on Cancer (AJCC) is responsible for the staging criteria for all cancers. For the past 20 years, the AJCC cancer staging manual has grouped all nonmelanoma skin cancers, including cSCC, together for the purposes of staging. However, based on new evidence, the AJCC has determined that cSCC should have a separate staging system in the 7th edition AJCC staging manual.

Objective

We sought to present the rationale for and characteristics of the new AJCC staging system specific to cSCC tumor characteristics (T).

Methods

The Nonmelanoma Skin Cancer Task Force of AJCC reviewed relevant data and reached expert consensus in creating the 7th edition AJCC staging system for cSCC. Emphasis was placed on prospectively accumulated data and multivariate analyses. Concordance with head and neck cancer staging system was also achieved.

Results

A new AJCC cSCC T classification is presented. The T classification is determined by tumor diameter, invasion into cranial bone, and high-risk features, including anatomic location, tumor thickness and level, differentiation, and perineural invasion.

Limitations

The data available for analysis are still suboptimal, with limited prospective outcomes trials and few multivariate analyses.

Conclusions

The new AJCC staging system for cSCC incorporates tumor-specific (T) staging features and will encourage coordinated, consistent collection of data that will be the basis of improved prognostic systems in the future.

Le texte complet de cet article est disponible en PDF.

Key words : American Joint Committee on Cancer staging system, anatomic site, cutaneous squamous cell carcinoma, depth of tumor, high-risk tumor features, histopathologic grade or differentiation, perineural invasion, prognosis, skin cancer, staging criteria, tumor diameter

Abbreviations used : AJCC, cSCC, MCC, NMSC, OTR, PNI, SCC


Plan


 Dr Liégeois is supported with a Career Development Award from the Dermatology Foundation.
 Disclosure: Dr Liégeois is president and founder of Meridian Skin Care Limited. The rest of the authors have no conflict of interest to declare.


© 2010  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 64 - N° 6

P. 1051-1059 - juin 2011 Retour au numéro
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