Protocol for Specimens of Squamous Cell Carcinoma of the Skin

David Cassarino, MD, PhD

Squamous Cell Carcinoma of the Skin
	Biopsy, Excision, Reexcision, Lymphadenectomy
*Procedure*
____ Biopsy, punch
____ Biopsy, shave
____ Biopsy, other (specify): ______________________________
____ Excision, ellipse
____ Excision, wide
____ Excision, other (specify): ______________________________
____ Reexcision, ellipse
____ Reexcision, wide
____ Reexcision, other (specify): ______________________________
____ Lymphadenectomy, sentinel node(s)
____ Lymphadenectomy, regional nodes (specify): ______________________________
____ Other (specify): ______________________________
____ Not specified
*Tumor Site*
	Specify, if known: ______________________________
____ Not specified
*Tumor Size*
	Greatest dimension: __________ cm
	*Additional dimensions: __________ x __________ cm
____ Cannot be determined
*Histologic Type (select all that apply)*
____ Squamous cell carcinoma (SCC)
	*____ Acantholytic SCC
	*____ Spindle cell (sarcomatoid) SCC
	*____ Verrucous SCC
	*____ Pseudovascular SCC
	*____ Adenosquamous carcinoma
	*____ Squamous cell carcinoma, type not otherwise specified
	*____ Other (specify): ______________________________
*Histologic Grade*
____ GX: Cannot be assessed
____ G1: Well differentiated
____ G2: Moderately differentiated
____ G3: Poorly differentiated
____ G4: Undifferentiated
*Maximum Tumor Thickness*
____ Not applicable
	Thickness: __________ mm
	Thickness: At least __________ mm
*Margins (select all that apply)*
	Peripheral margins
	____ Cannot be assessed
	____ Uninvolved by invasive carcinoma
		*Distance of invasive carcinoma from closest peripheral margin: __________ mm
		*Specify location(s), if possible: ______________________________
	____ Involved by invasive carcinoma
		Specify location(s), if possible: ______________________________
	____ Uninvolved by carcinoma in situ
		*Distance of carcinoma in situ from closest peripheral margin: __________ mm
		*Specify location(s), if possible: ______________________________
	____ Involved by carcinoma in situ
		Specify location(s), if possible: ______________________________
	Deep margin
	____ Cannot be assessed
	____ Uninvolved by invasive carcinoma
		*Distance of invasive carcinoma from margin: __________ mm
		*Specify location(s), if possible: ______________________________
	____ Involved by invasive carcinoma
		Specify location(s), if possible: ______________________________
*Lymph-Vascular Invasion*
____ Not identified
____ Present
____ Indeterminate
*Perineural Invasion*
____ Not identified
____ Present
____ Indeterminate
*Lymph Nodes*
____ No nodes submitted or found
	Number of lymph nodes examined
	Specify: __________
	____ Number cannot be determined (explain): ______________________________
	Number of lymph nodes involved by metastatic carcinoma
	Specify: __________
	____ Number cannot be determined (explain): ______________________________
	*Extranodal extension
	*____ Present
	*____ Not identified
*Pathologic Staging (pTNM)*
	TNM descriptors (required only if applicable) (select all that apply)
	____ m (multiple)
	____ r (recurrent)
	____ y (post treatment)
	Primary tumor (pT)
	____ pTX: Primary tumor cannot be assessed
	____ pT0: No evidence of primary tumor
	____ pTis: Carcinoma in situ
	____ pT1: Tumor ≤ 2 cm in greatest dimension with < 2 high-risk features
	____ pT2: Tumor > 2 cm in greatest dimension ± 1 additional high-risk feature, or any size with ≥ 2 high-risk features
	____ pT3: Tumor with invasion of maxilla, mandible, orbit, or temporal bone
	____ pT4: Tumor with direct or perineural invasion of skull base or axial skeleton
	Regional lymph nodes (pN)
	____ pNX: Regional lymph nodes cannot be assessed
	____ pN0: No regional lymph node metastasis
	____ pN1: Metastasis in a single ipsilateral lymph node ≤ 3 cm in greatest dimension ____ pN2: Metastasis in a single ipsilateral lymph node, > 3 cm but ≤ 6 cm in greatest dimension, or multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension, or in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension
		____ pN2a: Metastasis in a single ipsilateral lymph node, > 3 cm but ≤ 6 cm in greatest dimension
		____ pN2b: Metastasis in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension
		____ pN2c: Metastasis in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension
	____ pN3: Metastasis in a lymph node, > 6 cm in greatest dimension
	Distant metastasis (pM)
	____ Not applicable
	____ pM1: Distant metastasis
	*Specify site(s), if known: ______________________________
*Additional Pathologic Findings
	*Specify: ______________________________
Adapted with permission from College of American Pathologists, “Protocol for the Examination of Specimens from Patients with Squamous Cell Carcinoma of the Skin.” Web posting date: February 2011, www.cap.org. Protocol applies to invasive squamous cell carcinomas of the skin. Squamous cell carcinomas of the eyelid, vulva, and penis are not included. Note: Use of checklist is optional for tumors < 2 cm. *Data elements with asterisks are not required. These elements may be clinically important but are not yet validated or regularly used in patient management.