One of the first steps in determining your treatment plan is establishing the stage of your cancer. Unfortunately, there is no universally accepted staging system for squamous cell skin cancer (for more on the debate over staging systems, see SCIENCE SIDEBAR). Here we present a description of squamous cell skin cancer staging that is helpful for treatment planning. It is based on risk features and the designation of disease that is local and confined vs disease that has advanced (locally, to the lymph nodes, or beyond).
Local squamous cell skin cancer is generally characterized by smaller tumors with no high-risk features. It has a very low likelihood of advancing locally, becoming metastatic, or recurring. A typical situation would be a squamous cell skin cancer with no high-risk features on the trunk or extremities.
These are tumors that are still localized but have some high-risk features. They are at high risk for coming back locally (recurrence), becoming locally advanced, or spreading (metastasis).
The remaining cases can be described as advanced disease, which is the most challenging form of squamous cell skin cancer. Advanced disease includes tumors that have advanced locally (and can’t be managed with surgery), to the lymph nodes, or to sites far away in the body. The majority of people who die from squamous cell skin cancer initially present with advanced disease that is either locally advanced or regional (as discussed below).
We can think of a locally advanced squamous cell skin cancer as a subset of local squamous cell skin cancer with high-risk features. These are tumors that have already penetrated deep below the skin. Perhaps it’s helpful to think of the squamous cell skin cancer as a tree—a locally advanced case would be one where the roots get so big they lift up the sidewalk around the tree or reach so far down they wrap around sewer pipes and other underground structures, causing extensive damage. It is characterized by:
What are the challenges of locally advanced squamous cell skin cancer?
When squamous cell skin cancer spreads
Approximately four percent of squamous cell skin cancers will metastasize (spread) to the regional lymph nodes or to distant sites (other parts of the body). Patients who are immunosuppressed may have a two- to three-fold higher risk of metastasis, which means the risk for metastasis can be as high as 12 percent.
Regional disease is characterized by cancer that has spread to nearby lymph nodes. Lymph nodes are small, seed-shaped structures that contain clusters of immune cells. Their function is to filter the lymphatic fluid, which helps to clear waste material from the tissues and deliver white blood cells to fight infections. Lymph nodes are found throughout the body, notably in the neck, armpit, and groin. Cancer cells typically spread from the primary tumor to the nearest lymph node before traveling to other parts of the body.
How is regional disease diagnosed?
If the lymph node feels swollen or if lymph nodes are identified by imaging, then the doctor will take a sample from the lymph node for testing by
This term classifies disease that has spread to other sites in the body—either to far away lymph nodes or the lungs, brain, or other organs, resulting in distant metastasis.
Your doctor can advise you if you need imaging to look for metastatic disease. S/he may order imaging if you have certain symptoms or abnormal laboratory tests. The additional imaging may include computed tomography (CT) or positron emission tomography/computed tomography (PET-CT). It’s important to note that most patients with squamous cell skin cancer will not need a CT scan, since the risk of distant metastatic disease is only 0.4%.
Here are some questions you can ask your heathcare provider about your pathology report and squamous cell skin cancer staging. It might be helpful to review the previous page High-Risk Features as well as this page so you are familiar with some of the concepts/terminology.
Talking With Your Doctor About Your Biopsy Results
|Is this a particular type of squamous cell skin cancer?|
|Do I have any high-risk features? If so, how many and what are they?|
|What is my stage? What staging system are you using?|
|Is my squamous cell skin cancer localized or has it spread to my lymph nodes—or beyond?|
|Can I please have a copy of the pathology report?|
|What is my prognosis? How did you establish that?|
|Do I need a referral to any other specialists (such as a medical oncologist, radiation oncologist, or head-and-neck surgeon)?|