Skin Cancer - Staging: Basal cell and Squamous cell carcinomas

The AJCC 7th Edition (2009) has changed the TNM staging to incorporate risk factors. Tumor size has less importance.

T1: < 2 cm
T2: > 2 cm or > 1 risk factor
T3: Invades maxilla, mandible, orbit, temporal bone
T4: Perineural invasion of skull base, axial skeletal invasion

N1: single ipsilateral LN < 3 cm
N2a: Single ipsilateral LN 3 - 6 cm
N2b: Multiple ipsilateral LN < 6 cm
N2c: Multiple bilateral LNs < 6 cm
N3: LN > 6 cm

Stage I: T1N0
Stage II: T2N0
Stage III: T3N0; T1-3xN1
Stage IV: T4N0; TxN2; TxN3; TxNxM1

Risk Factors:

• Invasion: > 2 mm thick, Clark level IV or V; PNI
• Differentiation: Poorly differentiated or undifferentiated
  
• Location: Ear or non-hair bearing lip

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Work-up:
History + Physical exam
Biopsy: excisional or punch
CBC, LFTs, RFTs, PT/PTT/INR
Imaging only if clinical LNs or multiple risks: Regional CT and CXR