Focus Issue on Squamous Cell Carcinoma: Practical Concerns Regarding the 7th Edition AJCC Staging Guidelines

Area of Science:

• Oncology
• Dermatology
• Cancer Staging

Background:

• The 7th edition AJCC Cancer Staging Manual introduces evidence-based medicine for cutaneous squamous cell carcinoma (cSCC) staging.
• Previous editions lacked comprehensive, evidence-based guidelines for cSCC.
• This marks a significant shift towards improved clinical decision-making.

Purpose of the Study:

• To review key changes in cSCC staging from the 6th to the 7th edition AJCC manual.
• To identify impractical aspects and areas needing clarification in the 7th edition guidelines.
• To propose recommendations for improving future editions of the staging manual.

Main Methods:

• Comparative analysis of the 6th and 7th editions of the AJCC Cancer Staging Manual concerning cSCC.
• Focused review on specific changes: separate guidelines for cSCC and Merkel cell carcinoma (MCC), high-risk factor incorporation, advanced T stage guidelines, and lymph node status stratification.
• Modification of a comprehensive review on nonmelanoma skin cancer staging.

Main Results:

• The 7th edition incorporates separate staging for cSCC and MCC.
• High-risk factors are now used as T stage modifiers.
• New guidelines for advanced T stage and revised lymph node stratification are introduced.

Conclusions:

• The 7th edition represents a significant improvement in cSCC staging, enhancing patient stratification and prognostic accuracy.
• Certain aspects of the 7th edition require clarification and practical adjustments for clinical implementation.
• Recommendations are provided to address current shortcomings and refine future staging guidelines.