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The stage of a basal or squamous cell skin cancer is a way of describing how large the cancer is and how far it has spread. Knowing the stage is important to help determine your treatment options and to get an idea of how likely the cancer is to come back after treatment.
Staging is the process of figuring out if the cancer has spread, and if so, how far. The stage of a cancer describes how much cancer is in the body.
The stage of a basal or squamous cell skin cancer is based on the results of the physical exam, the skin biopsy (and any other biopsies), and imaging tests if they are done.
For basal cell skin cancers (BCCs), staging is rarely needed, because these cancers are almost always cured before they spread to other parts of the body.
Squamous cell skin cancers (SCCs) are more likely to spread (although this risk is still small), so determining the stage can be more important, particularly in people who are at higher risk. This includes people with weakened immune systems, such as those who have had organ transplants and people infected with HIV, the virus that causes AIDS. Most SCCs occur in the head and neck region. They tend to have a higher risk of recurring (coming back) or spreading compared to SCCs in other locations.
The system most often used to stage basal and squamous cell skin cancers is the American Joint Commission on Cancer (AJCC) TNM system. The most recent version, effective as of 2018, applies only to squamous and basal cell skin cancers of the head and neck area (lip, ear, face, scalp, and neck). The stage is based on 3 key pieces of information:
Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced.
Once a person’s T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage. The earliest stage of skin cancer is stage 0 (also called carcinoma in situ, or CIS). The other stages range from I (1) through IV (4). As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means cancer has spread more.
Although the AJCC system is most common, other staging systems have also been developed. For example, the Brigham and Women’s Hospital (BWH) tumor classification system uses different risk factors to stage squamous cell skin cancers of the head and neck area.
If your skin cancer is in the head and neck area, talk to your doctor about your specific stage. Cancer staging can be complex, so ask your doctor to explain it to you in a way you understand.
To learn more about how cancers are staged, see Cancer Staging.
The stage of a skin cancer can help give an idea of how serious the cancer is likely to be, but other factors can also be important. Some of these include:
Doctors look at these factors to help determine how likely it is that a skin cancer will come back after treatment (or spread to other parts of the body, in the case of squamous cell skin cancer).
The National Comprehensive Cancer Network (NCCN) is an alliance of many of the nation’s leading cancer centers that develops treatment guidelines for cancer care. The NCCN uses many of the factors above to divide both basal and squamous cell cancers into risk groups, which can be used to determine the best treatment options.
BCCs are divided into 2 risk groups: high and low risk, based on how likely they are to come back after treatment.
BCCs are at high risk of coming back after treatment if they have any of the following features:
BCCs that don’t have any of these features are in the low risk group.
To learn more about how these risk groups might affect your treatment options, see Treating Basal Cell Carcinoma.
SCCs are divided into 3 risk groups, based on how likely they are to spread or to come back after treatment.
SCCs in the very high risk group have an increased risk of both coming back after treatment and of spreading to another part of the body. They have at least one of the following features:
SCCs in the high risk group have an increased risk of coming back after treatment. These cancers don’t have any of the very high risk features above, but they have at least one of the following features:
SCCs that don’t have any of the features in either group above are in the low risk group.
To learn more about how these risk groups might affect your treatment options, see Treating Squamous Cell Carcinoma of the Skin.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
American Joint Committee on Cancer. Cutaneous Squamous Cell Carcinoma of the Head and Neck. In: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017: 171-181.
Christensen SR, Wilson LD, Leffell DJ. Chapter 90: Cancer of the Skin. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019.
National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology: Basal Cell Skin Cancer. Version 1.2023. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/nmsc.pdf on August 24, 2023.
National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology: Squamous Cell Skin Cancer. Version 1.2023. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/squamous.pdf on August 24, 2023.
Ruiz ES, Karia PS, Besaw R, Schmults CD. Performance of the American Joint Committee on Cancer Staging Manual, 8th Edition vs the Brigham and Women's Hospital Tumor Classification System for Cutaneous Squamous Cell Carcinoma. JAMA Dermatol. 2019;155(7):819-825.
Vidimos A, Stultz T. Evaluation for locoregional and distant metastases in cutaneous squamous cell and basal cell carcinoma. UpToDate. 2023. Accessed at https://www.uptodate.com/contents/evaluation-for-locoregional-and-distant-metastases-in-cutaneous-squamous-cell-and-basal-cell-carcinoma on August 24, 2023.
Xu YG, Aylward JL, Swanson AM, et al. Chapter 67: Nonmelanoma Skin Cancers. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020.
Last Revised: October 31, 2023
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