Type
First, remember that not all lumps and bumps and lesions on the skin are cancer. Some of these lesions must be removed because they are abnormal and could possibly become cancerous. Some common precancerous lesions are:
- Actinic keratoses
- Keratoacanthoma
- Bowen’s Disease
However, if a diagnosis of skin cancer is made, the type, grade and stage of the skin cancer are important parts of a diagnosis. Doctors often establish a preliminary disease stage based on physical exam as well as biopsy findings. Further evaluation may include imaging to help identify the spread of disease.
The most common types of skin cancer are cutaneous malignant melanoma and non-melanoma skin cancer (NMSC).
Melanoma
Melanoma is a type of cancer that comes from melanocytes, which are melanin-producing cells. When melanoma is on the skin, it is called cutaneous malignant melanoma. When it is on inner body surfaces (such as inside the nose or mouth), it is called mucosal malignant melanoma.
Cutaneous Malignant Melanoma (Melanoma of the Skin)
There are a number of subtypes of melanoma of the skin. These differ based on their appearance and special features seen only under the microscope.
Types of Cutaneous Malignant Melanoma
Superficial spreading melanoma
Nodular melanoma
Lentigo maligna melanoma
Acral lentiginous melanoma
Desmoplastic melanoma
Melanoma arising from a blue nevus
Melanoma arising in a giant congenital nevus
Melanoma of childhood
Nevoid melanoma
Mucosal Malignant Melanoma
This is a very rare type of melanoma that arises from mucosal surfaces, such as the inside of the nose and mouth. While there are mucosal surfaces throughout the body, around 50% of all mucosal melanomas are found in the head and neck region. The outcome of these cancers is generally worse than that of cutaneous malignant melanoma.
Non-Melanoma Skin Cancer (NMSC)
Non-Melanoma skin cancers (NMSC) originate from cells other than melanocytes. In this group, skin cancers start from cells called keratinocytes, which are in the outer layer of the skin. The most common types of NMSC are basal cell carcinoma and squamous cell carcinoma, but there are several other types as well.
Basal cell carcinoma
These are cancers arising from the cells in the deepest layer of the epidermis (the outermost layer of skin). These are the most common type of NMSC, making up about 70 to 75 percent of all skin cancers. They are also the most common cancer in the U.S. Some people even have multiple basal cell carcinomas. They are generally very slow growing, slow to invade deeply, and rarely spread to lymph nodes. However, some types can be more aggressive than others. Subtypes of basal cell carcinoma include:
- Superficial basal cell carcinoma
- Nodular (solid) basal cell carcinoma
- Micronodular basal cell carcinoma
- Infiltrating basal cell carcinoma
- Fibroepithelial basal cell carcinoma
- Basal cell carcinoma with adnexal differentiation
- Basosquamous carcinoma
- Keratotic basal cell carcinoma
Squamous cell carcinoma
This is the second most common type of NMSC, and it refers to cancers arising from cells in the middle and outer layers of the skin. In general, these are more aggressive and are more likely to spread to lymph nodes than are basal cell carcinomas. Subtypes of squamous cell carcinoma include:
- Acantholytic squamous cell carcinoma
- Spindle-cell squamous cell carcinoma
- Verrucous squamous cell carcinoma
- Pseudovascular squamous cell carcinoma
- Adenosquamous carcinoma
Other types of NMSC
There are several other types of NMSC besides basal cell and squamous cell carcinoma. About 5% of non-melanoma skin cancers actually arise from cells in the skin that are not epithelial (not from the outer lining). These include adnexal cancers (next to an organ), neural cancers, soft tissue cancers, and hematolymphoid cancers. Additional types of NMSC include:
- Merkel cell carcinoma: This is a type of cancer arising from Merkel cells in the epidermis. These are very rare skin cancers, but they can be quite aggressive. They can also recur or spread to lymph nodes as well as spread throughout the body.
- Sebaceous carcinoma: This is cancer from cells that make up the oil glands in the skin. Most of these cancers are found in the skin around the eye. These are usually slow growing but should be treated by a doctor who specializes in cancer.
Other less common NMSCs:
- Atypical fibroxanthoma
- Carcinoma of the sweat glands
- Pilomatrical carcinoma
- Proliferating trichilemmal tumor
- Microcystic adnexal carcinoma
- Porocarcinoma
- Spiradenocarcinoma
- Hidradenocarcinoma
- Mucinous carcinoma
- Apocrine carcinoma
- Primitive neuroectodermal tumor (PNET)
- Granular cell tumor
- Dermatofibrosarcoma protuberans
- Cutaneous angiosarcoma
Additional Cancer Types
Since there are lymphatic tissues in the skin, lymphomas (cancer in lymphocytes) can also be found in the skin. These cancers should be evaluated and treated by a medical oncologist.
Finally, even more rarely, spread of cancers from other sites can appear in the skin. This includes spread from lung, kidney, breast or ovarian cancer.
Grade
A doctor will rely on final pathology of the tumor to determine the grade and stage of the cancer. The grade is usually only determined based on a biopsy. The grade of cancer relates to how healthy or unhealthy cells look under a microscope. In other words, a pathologist will determine the grade of cancer by comparing the amount of the healthy-looking tissue to the amount of cancerous tissue. If most of the tumor cells look like normal tissue then the cancer is “well differentiated” or “low-grade.” However, if the tumor cells look very different from normal tissue then the cancer is “poorly differentiated” or “high-grade.” The grade of cancer may help to determine how quickly the cancer is likely to spread.
Grades of Skin Cancer
- GX The grade cannot be evaluated.
- G1 The cells look more like normal tissue and are well differentiated.
- G2 The cells are only moderately differentiated.
- G3 and G4 The cells don’t look like normal tissue and are poorly differentiated.
Stage
The stage of a cancer is determined by the TNM staging system:
- The ‘T’ stands for tumor size.
- The ‘N’ stands for lymph node involvement.
- The ‘M’ stands for distant metastases, or cancer spread to other areas of the body.
Staging will help doctors determine how serious the cancer is and how best to treat it. Staging systems often reference very specific anatomical structures. Please see the Anatomy page to learn about the terms mentioned in these tables.
Staging of Malignant Melanoma
The tables below will explain each stage of Malignant Melanoma. For patients who do not know their stage, this table can be used to determine stage based on T, N, and M characteristics.
Staging Overview
| T | N | M | Stage |
|---|---|---|---|
| Tis | N0 | M0 | 0 |
| T1a | N0 | M0 | IA |
| T1b | N0 | M0 | IA |
| T2a | N0 | M0 | IB |
| T2b | N0 | M0 | IIA |
| T3a | N0 | M0 | IIA |
| T3b | N0 | M0 | IIB |
| T4a | N0 | M0 | IIB |
| T4b | N0 | M0 | IIC |
| T0 | N1b, N1c | M0 | IIIB |
| T0 | N2b, N1c, N3b or N3c | M0 | IIIC |
| T1a/b – T2a | N1a or N2a | M0 | IIIA |
| T1a/b – T2a | N1b/c or N2b | M0 | IIIB |
| T2b/T3a | N1a – N2b | M0 | IIIB |
| T1a -T3a | N2c or N3a/b/c | M0 | IIIC |
| T3b/T4a | Any N ≥ N1 | M0 | IIIC |
| T4b | N1a -N2c | M0 | IIIC |
| T4b | N3a/b/c | M0 | IIID |
| Any T, Tis | Any N | M1 | IV |
American Joint Committee on Cancer, 8th Ed. 2017
Stage 0
Tis, N0, M0
- The cancer is in situ, meaning it has not invaded into deeper layers.
- There is no evidence of any spread to the lymph nodes.
- There is no evidence of distant spread to other parts of the body.
Stage 1A
T1a, N0, M0
- The tumor thickness is 0.8 mm or less (without ulceration or unknown ulceration).
- There is no evidence of any spread to the lymph nodes.
- There is no evidence of distant spread to other parts of the body.
T1b, N0, M0
- The tumor thickness is 0.8 mm or less (with ulceration) or 0.8 mm to 1.0 mm (with or without ulceration).
- There is no evidence of any spread to the lymph nodes.
- There is no evidence of distant spread to other parts of the body.
Stage 1B
T2a, N0, M0
- The tumor thickness is greater than 1 mm to 2 mm (without ulceration).
- There is no evidence of any spread to the lymph nodes.
- There is no evidence of distant spread to other parts of the body.
Stage 2A
T2b, N0, M0
- The tumor thickness is greater than 1 mm to 2 mm (with ulceration).
- There is no evidence of any spread to the lymph nodes.
- There is no evidence of distant spread to other parts of the body.
T3a, N0, M0
- The tumor thickness is greater than 2 mm to 4 mm (without ulceration).
- There is no evidence of any spread to the lymph nodes.
- There is no evidence of distant spread to other parts of the body.
Stage 2B
T3b, N0, M0
- The tumor thickness is greater than 2 mm to 4 mm (with ulceration).
- There is no evidence of any spread to the lymph nodes.
- There is no evidence of distant spread to other parts of the body.
T4a, N0, M0
- The tumor thickness is more than 4.0 mm (without ulceration).
- There is no evidence of any spread to the lymph nodes.
- There is no evidence of distant spread to other parts of the body.
Stage 2C
T4b, N0, M0
- The tumor thickness is more than 4.0 mm (with ulceration).
- There is no evidence of any spread to the lymph nodes.
- There is no evidence of distant spread to other parts of the body.
Stage 3A
T1a, N1a, M0
- The tumor thickness is 0.8 mm or less (without ulceration or unknown ulceration).
- Spread to 1 lymph node, with micrometastasis (detected on pathology).
- There is no evidence of distant spread to other parts of the body.
T1a, N2a, M0
- The tumor thickness is 0.8 mm or less (without ulceration or unknown ulceration).
- Spread to 2-3 lymph nodes, with micrometastasis (detected on pathology).
- There is no evidence of distant spread to other parts of the body.
T1b, N1a, M0
- The tumor thickness is 0.8 mm or less (with ulceration) or 0.8 mm to 1.0 mm (with or without ulceration).
- Spread to 1 lymph node, with micrometastasis (detected on pathology).
- There is no evidence of distant spread to other parts of the body.
T1b, N2a, M0
- The tumor thickness is 0.8 mm or less (with ulceration) or 0.8 mm to 1.0 mm (with or without ulceration).
- Spread to 2-3 lymph nodes, with micrometastasis (detected on pathology).
- There is no evidence of distant spread to other parts of the body.
T2a, N1a, M0
- The tumor thickness is greater than 1 mm to 2 mm (without ulceration).
- Spread to 1 lymph node, with micrometastasis (detected on pathology).
- There is no evidence of distant spread to other parts of the body.
T2a, N2a, M0
- The tumor thickness is greater than 1 mm to 2 mm (without ulceration).
- Spread to 2-3 lymph nodes, with micrometastasis (detected on pathology).
- There is no evidence of distant spread to other parts of the body.
Stage 3B
T1A
T1a, N1b, M0
- The tumor thickness is 0.8 mm or less (without ulceration or unknown ulceration).
- Spread to 1 lymph node, with macrometastasis (clinically detected).
- There is no evidence of distant spread to other parts of the body.
T1a, N1c, M0
- The tumor thickness is 0.8 mm or less (without ulceration or unknown ulceration).
- No regional lymph node disease, but in transit or satellite metastases.
- There is no evidence of distant spread to other parts of the body.
T1a, N2b, M0
- The tumor thickness is 0.8 mm or less (without ulceration or unknown ulceration).
- Spread to 2-3 lymph nodes, with macrometastasis (clinically detected).
- There is no evidence of distant spread to other parts of the body.
T1B
T1b, N1b, M0
- The tumor thickness is 0.8 mm or less (with ulceration) or 0.8 mm to 1.0 mm (with or without ulceration).
- Spread to 1 lymph node, with macrometastasis (clinically detected).
- There is no evidence of distant spread to other parts of the body.
T1b, N1c, M0
- The tumor thickness is 0.8 mm or less (with ulceration) or 0.8 mm to 1.0 mm (with or without ulceration).
- No regional lymph node disease, but in transit or satellite metastases.
- There is no evidence of distant spread to other parts of the body.
T1b, N2b, M0
- The tumor thickness is 0.8 mm or less (with ulceration) or 0.8 mm to 1.0 mm (with or without ulceration).
- Spread to 2-3 lymph nodes, with macrometastasis (clinically detected).
- There is no evidence of distant spread to other parts of the body.
T2A
T2a, N1b, M0
- The tumor thickness is greater than 1 mm to 2 mm (without ulceration).
- Spread to 1 lymph node, with macrometastasis (clinically detected).
- There is no evidence of distant spread to other parts of the body.
T2a, N1c, M0
- The tumor thickness is greater than 1 mm to 2 mm (without ulceration).
- No regional lymph node disease, but in transit or satellite metastases.
- There is no evidence of distant spread to other parts of the body.
T2a, N2b, M0
- The tumor thickness is greater than 1 mm to 2 mm (without ulceration).
- Spread to 2-3 lymph nodes, with macrometastasis (clinically detected).
- There is no evidence of distant spread to other parts of the body.
T2B
T2b, N1a, M0
- The tumor thickness is greater than 1 mm to 2 mm (with ulceration).
- Spread to 1 lymph node, with micrometastasis (detected on pathology).
- There is no evidence of distant spread to other parts of the body.
T2b, N1b, M0
- The tumor thickness is greater than 1 mm to 2 mm (with ulceration).
- Spread to 1 lymph node, with macrometastasis (clinically detected).
- There is no evidence of distant spread to other parts of the body.
T2b, N2a, M0
- The tumor thickness is greater than 1 mm to 2 mm (with ulceration).
- Spread to 2-3 lymph nodes, with micrometastasis (detected on pathology).
- There is no evidence of distant spread to other parts of the body.
T2b, N2b, M0
- The tumor thickness is greater than 1 mm to 2 mm (with ulceration).
- Spread to 2-3 lymph nodes, with macrometastasis (clinically detected).
- There is no evidence of distant spread to other parts of the body.
T3A
T3a, N1a, M0
- The tumor thickness is greater than 2 mm to 4 mm (without ulceration).
- Spread to 1 lymph node, with micrometastasis (detected on pathology).
- There is no evidence of distant spread to other parts of the body.
T3a, N1b, M0
- The tumor thickness is greater than 2 mm to 4 mm (without ulceration).
- Spread to 1 lymph node, with macrometastasis (clinically detected).
- There is no evidence of distant spread to other parts of the body.
T3a, N2a, M0
- The tumor thickness is greater than 2 mm to 4 mm (without ulceration).
- Spread to 2-3 lymph nodes, with micrometastasis (detected on pathology).
- There is no evidence of distant spread to other parts of the body.
T3a, N2b, M0
- The tumor thickness is greater than 2 mm to 4 mm (without ulceration).
- Spread to 2-3 lymph nodes, with macrometastasis (clinically detected).
- There is no evidence of distant spread to other parts of the body.
Stage 3C
T1
T1a, N2c, M0
- The tumor thickness is 0.8 mm or less (without ulceration or unknown ulceration).
- Spread to at least one lymph node, with in-transit or satellite metastasis.
- There is no evidence of distant spread to other parts of the body.
T1a, N3a, M0
- The tumor thickness is 0.8 mm or less (without ulceration or unknown ulceration).
- Spread to 4 or more lymph nodes, with micrometastasis (detected on pathology).
- There is no evidence of distant spread to other parts of the body.
T1a, N3b, M0
- The tumor thickness is 0.8 mm or less (without ulceration or unknown ulceration).
- Spread to 4 or more lymph nodes, at least one with macrometastasis (clinically detected), or the presence of any matted nodes (stuck together).
- There is no evidence of distant spread to other parts of the body.
T1a, N3c, M0
- The tumor thickness is 0.8 mm or less (without ulceration or unknown ulceration).
- Spread to 4 or more lymph nodes, at least 2 of which are clinically evident, and/or the presence of any matted nodes (stuck together), with in-transit or satellite metastasis.
- There is no evidence of distant spread to other parts of the body.
T1b, N2c, M0
- The tumor thickness is 0.8 mm or less (with ulceration) or 0.8 mm to 1.0 mm (with or without ulceration).
- Spread to at least one lymph node, with in-transit or satellite metastasis.
- There is no evidence of distant spread to other parts of the body.
T1b, N3a, M0
- The tumor thickness is 0.8 mm or less (with ulceration) or 0.8 mm to 1.0 mm (with or without ulceration).
- Spread to 4 or more lymph nodes, with micrometastasis (detected on pathology).
- There is no evidence of distant spread to other parts of the body.
T1b, N3b, M0
- The tumor thickness is 0.8 mm or less (with ulceration) or 0.8 mm to 1.0 mm (with or without ulceration).
- Spread to 4 or more lymph nodes, at least one with macrometastasis (clinically detected), or the presence of any matted nodes (stuck together).
- There is no evidence of distant spread to other parts of the body.
T1b, N3c, M0
- The tumor thickness is 0.8 mm or less (with ulceration) or 0.8 mm to 1.0 mm (with or without ulceration).
- Spread to 4 or more lymph nodes, at least 2 of which are clinically evident, and/or the presence of any matted nodes (stuck together), with in-transit or satellite metastasis.
- There is no evidence of distant spread to other parts of the body.
T2
T2a, N2c, M0
- The tumor thickness is greater than 1 mm to 2 mm (without ulceration).
- Spread to at least one lymph node, with in-transit or satellite metastasis.
- There is no evidence of distant spread to other parts of the body.
T2a, N3a, M0
- The tumor thickness is greater than 1 mm to 2 mm (without ulceration).
- Spread to 4 or more lymph nodes, with micrometastasis (detected on pathology).
- There is no evidence of distant spread to other parts of the body.
T2a, N3b, M0
- The tumor thickness is greater than 1 mm to 2 mm (without ulceration).
- Spread to 4 or more lymph nodes, at least one with macrometastasis (clinically detected), or the presence of any matted nodes (stuck together).
- There is no evidence of distant spread to other parts of the body.
T2a, N3c, M0
- The tumor thickness is greater than 1 mm to 2 mm (without ulceration).
- Spread to 4 or more lymph nodes, at least 2 of which are clinically evident, and/or the presence of any matted nodes (stuck together), with in-transit or satellite metastasis.
- There is no evidence of distant spread to other parts of the body.
T2b, N2c, M0
- The tumor thickness is greater than 1 mm to 2 mm (with ulceration).
- Spread to at least one lymph node, with in-transit or satellite metastasis.
- There is no evidence of distant spread to other parts of the body.
T2b, N3a, M0
- The tumor thickness is greater than 1 mm to 2 mm (with ulceration).
- Spread to 4 or more lymph nodes, with micrometastasis.
- There is no evidence of distant spread to other parts of the body.
T2b, N3b, M0
- The tumor thickness is greater than 1 mm to 2 mm (with ulceration).
- Spread to 4 or more lymph nodes, at least one with macrometastasis (clinically detected), or the presence of any matted nodes (stuck together).
- There is no evidence of distant spread to other parts of the body.
T2b, N3c, M0
- The tumor thickness is greater than 1 mm to 2 mm (with ulceration).
- Spread to 4 or more lymph nodes, at least 2 of which are clinically evident, and/or the presence of any matted nodes (stuck together), with in-transit or satellite metastasis.
- There is no evidence of distant spread to other parts of the body.
T3
T3a, N2c, M0
- The tumor thickness is greater than 2 mm to 4 mm (without ulceration).
- Spread to at least one lymph node, with in-transit or satellite metastasis.
- There is no evidence of distant spread to other parts of the body.
T3a, N3a, M0
- The tumor thickness is greater than 2 mm to 4 mm (without ulceration).
- Spread to 4 or more lymph nodes, with micrometastasis.
- There is no evidence of distant spread to other parts of the body.
T3a, N3b, M0
- The tumor thickness is greater than 2 mm to 4 mm (without ulceration).
- Spread to 4 or more lymph nodes, at least one with macrometastasis (clinically detected), or the presence of any matted nodes (stuck together).
- There is no evidence of distant spread to other parts of the body.
T3a, N3c, M0
- The tumor thickness is greater than 2 mm to 4 mm (without ulceration).
- Spread to 4 or more lymph nodes, at least 2 of which are clinically evident, and/or the presence of any matted nodes (stuck together), with in-transit or satellite metastasis.
- There is no evidence of distant spread to other parts of the body.
T3b, Any N ≥ N1, M0
- The tumor thickness is greater than 2 mm to 4 mm (with ulceration).
- Metastasis to at least 1 lymph node with any features.
- There is no evidence of distant spread to other parts of the body.
T4
T4a, Any N ≥ N1, M0
- The tumor thickness is more than 4.0 mm (without ulceration).
- Metastasis to at least 1 lymph node with any features.
- There is no evidence of distant spread to other parts of the body.
T4b, N1a, M0
- The tumor thickness is more than 4.0 mm (with ulceration).
- Spread to 1 lymph node, with micrometastasis.
- There is no evidence of distant spread to other parts of the body.
T4b, N1b, M0
- The tumor thickness is more than 4.0 mm (with ulceration).
- Spread to 1 lymph node, with macrometastasis.
- There is no evidence of distant spread to other parts of the body.
T4b, N1c, M0
- The tumor thickness is more than 4.0 mm (with ulceration).
- No regional lymph node disease, but in transit or satellite metastases
- There is no evidence of distant spread to other parts of the body.
T4b, N2a, M0
- The tumor thickness is more than 4.0 mm (with ulceration).
- Spread to 2-3 lymph nodes, with micrometastasis.
- There is no evidence of distant spread to other parts of the body.
T4b, N2b, M0
- The tumor thickness is more than 4.0 mm (with ulceration).
- Spread to 2-3 lymph nodes, with macrometastasis.
- There is no evidence of distant spread to other parts of the body.
T4b, N2c, M0
- The tumor thickness is more than 4.0 mm (with ulceration).
- Spread to at least one lymph node, with in-transit or satellite metastasis.
- There is no evidence of distant spread to other parts of the body.
Stage 3D
T4b, N3a, M0
- The tumor thickness is more than 4.0 mm (with ulceration).
- Spread to 4 or more lymph nodes, with micrometastasis.
- There is no evidence of distant spread to other parts of the body.
T4b, N3b, M0
- The tumor thickness is more than 4.0 mm (with ulceration).
- Spread to 4 or more lymph nodes, at least one with macrometastasis (clinically detected), or the presence of any matted nodes (stuck together).
- There is no evidence of distant spread to other parts of the body.
T4b, N3c, M0
- The tumor thickness is more than 4.0 mm (with ulceration).
- Spread to 4 or more lymph nodes, at least 2 of which are clinically evident, and/or the presence of any matted nodes (stuck together), with in-transit or satellite metastasis.
- There is no evidence of distant spread to other parts of the body.
Stage 4
Any T, Any N, M1
- Any tumor thickness with or without ulceration.
- Any amount of lymph node metastasis.
- Distant metastasis to another part of the body.
* Ulceration is when the layer of skin over the cancer is broken, meaning that the cancer has grown through the skin.
Staging of Merkel Cell Carcinoma
The tables below will explain each stage of Merkel Cell Carcinoma. For patients who do not know their stage, this table can be used to determine stage based on T, N, and M characteristics.
Staging Overview
| T | N | M | Stage |
|---|---|---|---|
| Tis | N0 | M0 | 0 |
| T1 | N0 | M0 | I |
| T2-3 | N0 | M0 | IIA |
| T4 | N0 | M0 | IIB |
| T1-4 | N1a(sn) or N1a | M0 | IIIA |
| T0 | N1b | M0 | IIIA |
| T1-4 | N1-3 | M0 | IIIB |
| T0-4 | Any N | M1 | IV |
American Joint Committee on Cancer, 8th Ed. 2017
Stage 0
Tis, N0, M0
- The cancer is in situ, meaning it has not invaded into deeper layers.
- There is no evidence of any spread to the lymph nodes.
- There is no evidence of distant spread to other parts of the body.
Stage 1
T1, N0, M0
- The tumor is 2 cm or less at its largest point.
- There is no evidence of any spread to the lymph nodes.
- There is no evidence of distant spread to other parts of the body.
Stage 2A
T2, N0, M0
- The tumor is more than 2 cm but not more than 5 cm at its largest point.
- There is no evidence of any spread to the lymph nodes.
- There is no evidence of distant spread to other parts of the body.
T3, N0, M0
- The tumor is more than 5 cm at its largest point.
- There is no evidence of any spread to the lymph nodes.
- There is no evidence of distant spread to other parts of the body.
Stage 2B
T4, N0, M0
- The tumor invades bones, muscles, fascia or cartilage.
- There is no evidence of any spread to the lymph nodes.
- There is no evidence of distant spread to other parts of the body.
Stage 3A
T1
T1, N1a(sn), M0
- The tumor is 2 cm or less at its largest point.
- Metastasis to regional lymph nodes that are not clinically obvious, but are identified on pathology following a sentinel lymph node biopsy.
- There is no evidence of distant spread to other parts of the body.
T1, N1a, M0
- The tumor is 2 cm or less at its largest point.
- Metastasis to regional lymph nodes that are not clinically obvious, but are identified on pathology following a lymph node dissection.
- There is no evidence of distant spread to other parts of the body.
T2
T2, N1a(sn), M0
- The tumor is more than 2 cm but not more than 5 cm at its largest point.
- Metastasis to regional lymph nodes that are not clinically obvious, but are identified on pathology following a sentinel lymph node biopsy.
- There is no evidence of distant spread to other parts of the body.
T2, N1a, M0
- The tumor is more than 2 cm but not more than 5 cm at its largest point.
- Metastasis to regional lymph nodes that are not clinically obvious, but are identified on pathology following a lymph node dissection.
- There is no evidence of distant spread to other parts of the body.
T3
T3, N1a(sn), M0
- The tumor is more than 5 cm at its largest point.
- Metastasis to regional lymph nodes that are not clinically obvious, but are identified on pathology following a sentinel lymph node biopsy.
- There is no evidence of distant spread to other parts of the body.
T3, N1a, M0
- The tumor is more than 5 cm at its largest point.
- Metastasis to regional lymph nodes that are not clinically obvious, but are identified on pathology following a lymph node dissection.
- There is no evidence of distant spread to other parts of the body.
T4
T4, N1a(sn), M0
- The tumor invades bones, muscles, fascia or cartilage.
- Metastasis to regional lymph nodes that are not clinically obvious, but are identified on pathology following a sentinel lymph node biopsy.
- There is no evidence of distant spread to other parts of the body.
T4, N1a, M0
- The tumor invades bones, muscles, fascia or cartilage.
- Metastasis to regional lymph nodes that are not clinically obvious, but are identified on pathology following a lymph node dissection.
- There is no evidence of distant spread to other parts of the body.
T0, N1b, M0
- There is no evidence of a primary tumor.
- Metastasis to regional lymph nodes that are enlarged and visible, and confirmed on pathology.
- There is no evidence of distant spread to other parts of the body.
Stage 3B
T1
T1, N1, M0
- The tumor is 2 cm or less at its largest point.
- Metastasis to regional lymph nodes.
- There is no evidence of distant spread to other parts of the body.
T1, N2, M0
- The tumor is 2 cm or less at its largest point.
- In-transit metastasis, meaning that there is a tumor separate from the main lesion and located either between the main lesion and the draining lymph nodes or anywhere further away (distal) from the primary tumor, without lymph node metastasis.
- There is no evidence of distant spread to other parts of the body.
T1, N3, M0
- The tumor is 2 cm or less at its largest point.
- In-transit metastasis, meaning that there is a tumor separate from the main lesion and located either between the main lesion and the draining lymph nodes or anywhere further away (distal) from the primary tumor, with lymph node metastasis.
- There is no evidence of distant spread to other parts of the body.
T2
T2, N1, M0
- The tumor is more than 2 cm but not more than 5 cm at its largest point.
- Metastasis to regional lymph nodes.
- There is no evidence of distant spread to other parts of the body.
T2, N2, M0
- The tumor is more than 2 cm but not more than 5 cm at its largest point.
- In-transit metastasis, meaning that there is a tumor separate from the main lesion and located either between the main lesion and the draining lymph nodes or anywhere further away (distal) from the primary tumor, without lymph node metastasis.
- There is no evidence of distant spread to other parts of the body.
T2, N3, M0
- The tumor is more than 2 cm but not more than 5 cm at its largest point.
- In-transit metastasis, meaning that there is a tumor separate from the main lesion and located either between the main lesion and the draining lymph nodes or anywhere further away (distal) from the primary tumor, with lymph node metastasis.
- There is no evidence of distant spread to other parts of the body.
T3
T3, N1, M0
- The tumor is more than 5 cm at its largest point.
- Metastasis to regional lymph nodes.
- There is no evidence of distant spread to other parts of the body.
T3, N2, M0
- The tumor is more than 5 cm at its largest point.
- In-transit metastasis, meaning that there is a tumor separate from the main lesion and located either between the main lesion and the draining lymph nodes or anywhere further away (distal) from the primary tumor, without lymph node metastasis.
- There is no evidence of distant spread to other parts of the body.
T3, N3, M0
- The tumor is more than 5 cm at its largest point.
- In-transit metastasis, meaning that there is a tumor separate from the main lesion and located either between the main lesion and the draining lymph nodes or anywhere further away (distal) from the primary tumor, with lymph node metastasis.
- There is no evidence of distant spread to other parts of the body.
T4
T4, N1, M0
- The tumor invades bones, muscles, fascia or cartilage.
- Metastasis to regional lymph nodes.
- There is no evidence of distant spread to other parts of the body.
T4, N2, M0
- The tumor invades bones, muscles, fascia or cartilage.
- In-transit metastasis, meaning that there is a tumor separate from the main lesion and located either between the main lesion and the draining lymph nodes or anywhere further away (distal) from the primary tumor, without lymph node metastasis.
- There is no evidence of distant spread to other parts of the body.
T4, N3, M0
- The tumor invades bones, muscles, fascia or cartilage.
- In-transit metastasis, meaning that there is a tumor separate from the main lesion and located either between the main lesion and the draining lymph nodes or anywhere further away (distal) from the primary tumor, with lymph node metastasis.
- There is no evidence of distant spread to other parts of the body.
Stage 4
T0–4, Any N, M1
- Any tumor size or involvement.
- Any amount of lymph node involvement.
- Distant metastasis to another part of the body.
Staging of Cutaneous Squamous Cell Carcinoma & other Cutaneous Malignancies
The tables below will explain each stage of Cutaneous Malignancies. For patients who do not know their stage, this table can be used to determine stage based on T, N, and M characteristics.
Staging Overview
| T | N | M | Stage |
|---|---|---|---|
| Tis | N0 | M0 | 0 |
| T1 | N0 | M0 | I |
| T2 | N0 | M0 | II |
| T3 | N0 | M0 | III |
| T1 | N1 | M0 | III |
| T2 | N1 | M0 | III |
| T3 | N1 | M0 | III |
| T1 | N2 | M1 | IV |
| T2 | N2 | M0 | IV |
| T3 | N2 | M0 | IV |
| Any T | N3 | M0 | IV |
| T4 | Any N | M0 | IV |
| Any T | Any N | M1 | IV |
American Joint Committee on Cancer, 8th Ed. 2017
Stage 0
Tis, N0, M0
- The cancer is in situ, meaning it has not invaded into deeper layers.
- There is no evidence of any spread to the lymph nodes.
- There is no evidence of distant spread to other parts of the body.
Stage 1
T1, N0, M0
- The tumor is 2 cm or less at its largest point.
- There is no evidence of any spread to the lymph nodes.
- There is no evidence of distant spread to other parts of the body.
Stage 2
T2, N0, M0
- The tumor is more than 2 cm but not more than 4 cm at its largest point.
- There is no evidence of any spread to the lymph nodes.
- There is no evidence of distant spread to other parts of the body.
Stage 3
T3, N0, M0
- The tumor is more than 4 cm at its largest point, or has minor bone erosion, perineural invasion, or deep invasion (invasion beyond the subcutaneous fat or >6 mm).
- There is no evidence of any spread to the lymph nodes.
- There is no evidence of distant spread to other parts of the body.
T1, N1, M0
- The tumor is 2 cm or less at its largest point.
- Metastasis to a single lymph node on the same side as the primary tumor that is 3cm or less without ENE (extranodal extension, or growth of the cancer outside of the lymph node).
- There is no evidence of distant spread to other parts of the body.
T2, N1, M0
- The tumor is more than 2 cm but not more than 4 cm at its largest point.
- Metastasis to a single lymph node on the same side as the primary tumor that is 3cm or less without ENE (extranodal extension, or growth of the cancer outside of the lymph node).
- There is no evidence of distant spread to other parts of the body.
T3, N1, M0
- The tumor is more than 4 cm at its largest point, or has minor bone erosion, perineural invasion, or deep invasion (invasion beyond the subcutaneous fat or >6mm).
- Metastasis to a single lymph node on the same side as the primary tumor that is 3cm or less without ENE (extranodal extension, or growth of the cancer outside of the lymph node).
- There is no evidence of distant spread to other parts of the body.
Stage 4
T1, N2, M1
- The tumor is 2 cm or less at its largest point.
- Metastasis to a single lymph node on the same side as the primary tumor that is 3 cm or less without ENE (extranodal extension, or growth of the cancer outside of the lymph node); a single lymph node on the same side as the primary tumor that is between 3 cm and 6 cm without ENE; multiple lymph nodes on the same side as the primary tumor that are smaller than 6 cm without ENE; or lymph nodes on the same side and/or opposite side of the primary tumor that are smaller than 6 cm without ENE.
- Distant metastasis to another part of the body.
T2, N2, M0
- The tumor is more than 2 cm but not more than 4 cm at its largest point.
- Metastasis to a single lymph node on the same side as the primary tumor that is 3 cm or less without ENE (extranodal extension, or growth of the cancer outside of the lymph node); a single lymph node on the same side as the primary tumor that is between 3 cm and 6 cm without ENE; multiple lymph nodes on the same side as the primary tumor that are smaller than 6 cm without ENE; or lymph nodes on the same side and/or opposite side as the primary tumor that are smaller than 6 cm without ENE.
- There is no evidence of distant spread to other parts of the body.
T3, N2, M0
- The tumor is more than 4 cm at its largest point, or has minor bone erosion, perineural invasion, or deep invasion (invasion beyond the subcutaneous fat or >6mm).
- Metastasis to a single lymph node on the same side as the primary tumor that is 3 cm or less without ENE (extranodal extension, or growth of the cancer outside of the lymph node); a single lymph node on the same side as the primary tumor that is between 3 cm and 6 cm without ENE; multiple lymph nodes on the same side as the primary tumor that are smaller than 6 cm without ENE; or lymph nodes on the same side and/or opposite side as the primary tumor that are smaller than 6 cm without ENE.
- There is no evidence of distant spread to other parts of the body.
Any T, N3, M0
- Any tumor size or extent of involvement.
- Metastasis to a lymph node larger than 6 cm without ENE (extranodal extension, or growth of the cancer outside of the lymph node); a single lymph node on the same side as the primary tumor that are greater than 3 cm with ENE; or multiple lymph nodes on the same side and/or opposite side as the primary tumor if any have ENE.
- There is no evidence of distant spread to other parts of the body.
T4, Any N, M0
- The tumor invades the bone, skull base, and/or skull base foramen.
- Any amount of lymph node involvement.
- There is no evidence of distant spread to other parts of the body.
Any T, Any N, M1
- Any tumor size or extent of involvement.
- Any amount of lymph node involvement.
- Distant metastasis to another part of the body.
Additional Staging Information
Malignant Melanoma
Definition of T
TX The primary tumor cannot be evaluated.
T0 There is no evidence of a primary tumor.
Tis The cancer is in situ, meaning it has not invaded into deeper layers.
T1a The tumor thickness is 0.8 mm or less (without ulceration or unknown ulceration).
T1b The tumor thickness is 0.8 mm or less (with ulceration) or 0.8 mm to 1.0 mm (with or without ulceration).
T2a The tumor thickness is greater than 1 mm to 2 mm (without ulceration).
T2b The tumor thickness is greater than 1 mm to 2 mm (with ulceration).
T3a The tumor thickness is greater than 2 mm to 4 mm (without ulceration).
T3b The tumor thickness is greater than 2 mm to 4 mm (with ulceration).
T4a The tumor thickness is more than 4.0 mm (without ulceration).
T4b The tumor thickness is more than 4.0 mm (with ulceration).
Definition of N
NX The neck lymph nodes cannot be assessed (for example, they were removed for another reason in the past).
N0 There is no evidence of any spread to the lymph nodes. N1 – 1 node
- N1a if micrometastasis.
- N1b if macrometastasis.
- N1c no regional lymph node disease, but in transit or satellite metastases.
N2 – 2-3 nodes
- N2a if micrometastasis.
- N2b if macrometastasis.
- N2c if in-transit metastasis or satellite metastasis.
N3 – 4 or more nodes
- N3a if micrometastasis.
- N3b if macrometastasis or any number or nodes stuck together (matted).
- N3c if in-transit metastasis or satellite metastasis.
Definition of M
M0 No evidence of distant spread.
M1a Spread to the skin, tissue underneath the skin, or lymph nodes distant from the primary tumor and the regional group of lymph nodes.
M1b Spread to the lung.
M1c Non-central nervous system (CNS) visceral sites.
M1d CNS.
Merkel Cell Carcinoma
Definition of T
TX The primary tumor cannot be evaluated.
T0 There is no evidence of a primary tumor.
Tis The cancer is in situ, meaning it has not invaded into deeper layers.
T1 The tumor is 2 cm or less at its largest point.
T2 The tumor is more than 2 cm but not more than 5 cm at its largest point.
T3 The tumor is more than 5 cm at its largest point.
T4 The tumor invades bones, muscles, fascia or cartilage.
Definition of N
pNX The neck lymph nodes cannot be assessed.
pN0 After looking at lymph nodes under a microscope following removal, there is no evidence of spread to neck lymph nodes.
pN1a – Micrometastasis: Metastasis to regional lymph nodes that are not clinically obvious, but are identified on pathology following a lymph node dissection.
pN1a (sn) Sn: Metastasis to regional lymph nodes that are not clinically obvious, but are identified on pathology following a sentinel lymph node biopsy.
pN1b – Macrometastasis: Enlarged, clinically obvious lymph nodes that are identified before surgery and are then confirmed to be positive by final pathology after surgery.
pN2 – In transit spread: This is used when there is a tumor separate from the main lesion and located either between the main lesion and the draining lymph nodes or anywhere further away (distal) to the primary tumor without lymph node metastasis.
pN3 – In transit spread: This is used when there is a tumor separate from the main lesion and located either between the main lesion and the draining lymph nodes or anywhere further away (distal) to the primary tumor with lymph node metastasis.
Definition of M
M0 No evidence of distant spread.
M1a Spread to the skin, tissue underneath the skin, or lymph nodes distant from the primary tumor and the regional group of lymph nodes.
M1b Spread to the lung.
M1c Spread to any other body site.
Cutaneous Squamous Cell Carcinoma; other Cutaneous Malignancies
Definition of T
TX The primary tumor cannot be evaluated.
T0 There is no evidence of a primary tumor.
Tis The cancer is in situ, meaning it has not invaded into deeper layers.
T1 The tumor is 2 cm or less at its largest point.
T2 The tumor is more than 2 cm but not more than 5 cm at its largest point.
T3 The tumor is more than 5 cm at its largest point.
T4 The tumor invades bones, muscles, fascia or cartilage.
Definition of N
NX The neck lymph nodes cannot be assessed.
N0 There is no evidence of any spread to the lymph nodes.
cN0 Based on your doctor’s examination and review of the imaging, there do not seem to be any lymph nodes.
pN0 After looking at lymph nodes under a microscope following removal, there is no evidence of spread to neck lymph nodes.
N1a – Micrometastasis: This is used when one or more lymph nodes are removed “electively,” and it turns out there is cancer within the lymph nodes.
N1b – Macrometastasis: This is used when there are enlarged lymph nodes identified before removing them that are then confirmed to be positive under a microscopic test after removal.
N2 – In transit spread: This is used when there is a tumor separate from the main lesion and located either between the main lesion and the draining lymph nodes or anywhere further away (distal) to the primary tumor.
Definition of M
M0 No evidence of distant spread.
M1a Spread to the skin, tissue underneath the skin, or lymph nodes distant from the primary tumor and the regional group of lymph nodes.
M1b Spread to the lung.
M1c Spread to any other body site.
