Staging of Nonmelanoma Skin Cancer

After nonmelanoma skin cancer has been diagnosed, tests are done to find out if cancer cells have spread within the skin or to other parts of the body.

"Staging" is the process used to find out if cancer has spread within the skin or to other parts of the body.

The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.

There are three ways that cancer spreads in the body. These include:

  • Through tissue. Cancer invades the surrounding normal tissue.
  • Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
  • Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

Staging of nonmelanoma skin cancer depends on whether the tumor has certain "high-risk" features and if the tumor is on the eyelid.

Staging for nonmelanoma skin cancer that is on the eyelid is different from staging for nonmelanoma skin cancer that affects other parts of the body.

The following are high-risk features for nonmelanoma skin cancer that is not on the eyelid.

  • The tumor is thicker than 2 millimeters.
  • The tumor is described as Clark level IV (has spread into the lower layer of the dermis) or Clark level V (has spread into the layer of fat below the skin).
  • The tumor has grown and spread along nerve pathways.
  • The tumor began on an ear or on a lip that has hair on it.
  • The tumor has cells that look very different from normal cells under a microscope.

Stage 0 (Carcinoma in situ)

In stage 0, abnormal cells are found in the squamous cell or basal cell layer of the epidermis (topmost layer of the skin). These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed. The tumor is not larger than 2 centimeters at its widest point and may have one high-risk feature.

Stage II

In stage II, the tumor is either:

  • larger than 2 centimeters at its widest point; or
  • any size and has two or more high-risk features. (see list of high risk features)

Stage III

In stage III:

1) The tumor has spread to the jaw, eye socket, or side of the skull. Cancer may have spread to one lymph node on the same side of the body as the tumor. The lymph node is not larger than 3 centimeters.

2) Cancer has spread to one lymph node on the same side of the body as the tumor. The lymph node is not larger than 3 centimeters and one of the following is true:

  • the tumor is not larger than 2 centimeters at its widest point and may have one high-risk feature; or
  • the tumor is larger than 2 centimeters at its widest point; or
  • the tumor is any size and has two or more high-risk features.

Stage IV

In stage IV, one of the following is true:

  • The tumor is any size and may have spread to the jaw, eye socket, or side of the skull. Cancer has spread to one lymph node on the same side of the body as the tumor and the affected node is larger than 3 centimeters but not larger than 6 centimeters, or cancer has spread to more than one lymph node on one or both sides of the body and the affected nodes are not larger than 6 centimeters; or
  • The tumor is any size and may have spread to the jaw, eye socket, skull, spine, or ribs. Cancer has spread to one lymph node that is larger than 6 centimeters; or
  • The tumor is any size and has spread to the base of the skull, spine, or ribs. Cancer may have spread to the lymph nodes; or
  • Cancer has spread to other parts of the body, such as the lung.

Tests Used for Staging of High Risk Nonmelanoma Skin Cacner

The following tests and procedures may be used in the staging process for skin cancer that has high risk features (see above) or appear to be of an advanced stage.

  • CT scan (CAT scan). A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • MRI (magnetic resonance imaging). A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Lymph node biopsy. For squamous cell carcinoma, the lymph nodes may be removed and checked to see if cancer has spread to them.

Last updated June 6, 2013.

Refrence: National Cancer Institute

This information is for general educational uses only. It may not apply to you and your personal medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional.

Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your physician or health care professional.

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