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Skin carcinoma of the head and neck (ICD10 C44.0, C44.2-4)

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Introduction

This is the data sheet for TNM 8th edition staging of the skin carcinoma of the head and neck (ICD10 C44.0, C44.2-4)

For more detailed information regarding TNM staging, please see pages 136-138 of the UICC TNM 8 book or visit the Wiley and UICC website.

Stage groupings

Stage Group	T stage	N stage	M stage
Stage 0	Tis	N0	M0
Stage I	T1	N0	M0
Stage II	T2	N0	M0
Stage III	T3	N0	M0
	T1, T2, T3	N1	M0
Stage IVA	T1, T2, T3	N2, N3	M0
	T4	Any N	M0
Stage IVB	Any T	Any N	M1

TNM clinical classification

T - primary tumour

T value	Description
TX	Primary tumour cannot be identified
T0	No evidence of primary tumour
Tis	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 skull base or axial skeleton invasion including foraminal involvement and/or vertebral foramen involvement to the epidural space

Note:

* Deep invasion is defined as invasion beyond the subcutaneous fat or >6 mm (as measured from the granular layer of adjacent normal epidermis to the base of the tumour), perineural invasion for T3 classification is defined as clinical or radiographic involvement of named nerves without foramen or skull base invasion or transgression.

N - regional lymph nodes

N value	Description
N0	No regional lymph node metastasis
N1	Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension without extranodal extension
N2	Metastasis described as: N2a - Metastasis in a single ipsilateral lymph node more than 3 cm but not more than 6 cm in greatest dimension without extranodal extension N2b - Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension, without extranodal extension N2c - Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension, without extranodal extension
N3a	Metastasis in a lymph node more than 6 cm in greatest dimension without extranodal extension
N3b	Metastasis in a single or multiple lymph nodes with clinical extranodal extension*

Note:

* The presence of skin involvement or soft tissue invasion with deep fixation/tethering to underlying muscle or adjacent structures or clinical signs of nerve involvement is classified as clinical extranodal extension.

M - distant metastasis

M value	Description
M0	No distant metastasis
M1	Distant Metastasis

TNM pathological classification

pT - primary tumour

The pT categories correspond to the clinical T categories.

pN - regional lymph nodes

pN – Regional Lymph Nodes - Histological examination of a selective neck dissection specimen will ordinarily include 10 or more lymph nodes. Histological examination of a radical or modified radical neck dissection specimen will ordinarily include 15 or more lymph nodes.

pN value	Description
pNX	Regional lymph nodes cannot be assessed
pN0	No regional lymph node metastasis
pN1	Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension without extranodal extension
pN2	Metastasis described as: pN2a - Metastasis in a single ipsilateral lymph node, less than 3 cm in greatest dimension with extranodal extension or, more than 3 cm but not more than 6 cm in greatest dimension without extranodal extension pN2b - Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension, without extranodal extension pN2c - Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension, without extranodal extension
pN3a	Metastasis in a lymph node more than 6 cm in greatest dimension without extranodal extension
pN3b	Metastasis in a lymph node more than 3 cm in greatest dimension with extranodal extension or multiple ipsilateral, or any contralateral or bilateral node(s) with extranodal extension