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

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.

Clinical Findings, Treatments and Outcomes of Transplant Recipients with Metastatic Skin Cancer

“…Characteristics of aggressive primary skin cancers in our population are consistent with studies that found similar findings in SOTRs 18 . Farasat et al 19 concluded that up to 20% of high-risk SCCs in SOTRs may metastasize. SCCs were characterized as high-risk if they were poorly-differentiated or had perineural invasion, both of which were seen in our population 20 .…”

A Metastização Cervical dos Cancros Cutâneos de Cabeça e Pescoço

“…O grande passo da 7ª edição da classificação da AJCC foi separar o estadiamento do CEC de outros tumores cutâneos, e aproximá-lo do estadiamento dos tumores de cabeça e pescoço, tendo em conta a maior prevalência do CEC nessa área anatómica. 22 Contudo, ambas as classificações são consideradas ineficazes pelas seguintes razões:…”

“…16 19 (embora a classificação de AJCC na sua 7º edição sugira aos clínicos acrescentar a letra I, no final da classificação TNM, mas sem quantificar o seu significado para o prognóstico). 22 A classificação da AJCC prevê vários critérios classificados como de "alto-risco", cuja soma faz a distinção entre os está-dios T1 e T2. Porém, tal modelo é considerado de difícil aplicabilidade clínica, e difícil validação estatística, já que implica a divisão dos doentes por uma grande variedade de grupos, tornando as amostras em estudo muito pequenas para validação.…”

Advanced Squamous Cell Carcinoma of the Skin

“…In the sixth edition of the AJCC edition, the limit of 5 cm separated the tumors in T2 and T3, however this limit did not have enough evidence to be sustained and was abolished in the seventh edition, being replaced by parameters more related to the invasiveness than the diameter of tumor (Farasat, Yu et al 2011). …”