N1S3 Staging System of Forest et al for Cutaneous Squamous Cell Carcinom of the Head and Neck with Lymph Node Metastases

Description

Forest et al reported the N1S3 staging system for cutaneous squamous cell carcinomas of the head and neck that metastasize to lymph nodes. This can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Sydney in Australia.

Patient selection: squamous cell carcinoma of the skin of the head and neck

Sites of metastasis evaluated:

(1) parotid gland: includes both lymph nodes within the gland and the gland itself

(2) lymph nodes in the neck

Parameters:

(1) number of metastatic foci <= 3 cm in diameter

(2) number of metastatic foci > 3 cm in diameter

Sites <= 3 cm	Sites > 3 cm	Stage
0	0	0
1	0	I
0 or 1	1	II
>= 2	0 or 1	II
NA	>= 2	III

where:

• Extracapsular spread (ECS) is associated with survival but tends to be seen with a larger metastasis.

Interpretation:

• The stage correlates with locoregional control and disease-specific survival.

• The higher the Stage the greater the need for more aggressive management.

Stage	Locoregional Control at 6 Years	Disease Specific Survival at 5 Years
I	75%	90%
II	44%	75%
III	34%	42%

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N1S3 Staging System of Forest et al for Cutaneous Squamous Cell Carcinom of the Head and Neck with Lymph Node Metastases

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