One of the ﬁrst steps in determining your treatment plan is establishing the stage of your 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).
Low-risk (all of the following features)
High risk (any of the following)
Very high risk (any of the following)
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 tumour 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:
Cancer involving the lymph nodes. The diagram shows the primary tumour as well as the affected lymph nodes.
Skin cancer on the scalp that has spread through the lymphatics to a lymph node on the head.
Yellow sunburst shows the site of the primary tumour on the neck and spread to the lung, liver, and bone.
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
|Do I need further treatment? Or has the squamous cell skin cancer been fully treated?
|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 localised 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? Will I need further follow-up?
|Do I need a referral to any other specialists (such as a medical oncologist, radiation oncologist, or head-and-neck surgeon)?