8_skin

131

Skin Tumours

Introductory Notes The classifications apply to: carcinomas of the skin,* [excluding vulva (see page 161), penis (see page 188), and perianal skin (see page 77)], malignant melanomas of the skin including eyelid, and to Merkel cell carcinoma.

Anatomical Sites The following sites are identified by ICD‐O‐3 topography rubrics: ▪▪ Lip (excluding vermilion surface) (C44.0) ▪▪ Eyelid (C44.1) ▪▪ External ear (C44.2) ▪▪ Other and unspecified parts of face (C44.3) ▪▪ Scalp and neck (C44.4) ▪▪ Trunk excluding anal margin and perianal skin (C44.5) ▪▪ Upper limb and shoulder (C44.6) ▪▪ Lower limb and hip (C44.7) ▪▪ Scrotum (C63.2)

▪▪

▪▪ ▪▪ ▪▪ ▪▪ ▪▪

Each tumour type is described under the following headings: Rules for classification with the procedures for assessing T, N, and M categories Regional lymph nodes TNM clinical classification pTNM pathological classification Stage Prognostic factors grid

TNM Classification of Malignant Tumours, Eighth Edition. Edited by James D. Brierley, Mary K. Gospodarowicz and Christian Wittekind. © 2017 UICC. Published 2017 by John Wiley & Sons, Ltd.

Skin

Note * There is a new classification for carcinoma of the skin of the head and neck region.

132

Skin Tumours

Regional Lymph Nodes The regional lymph nodes are those appropriate to the site of the primary tumour.

Unilateral Tumours Head, neck: Ipsilateral preauricular, submandibular, cervical, and supra­ clavicular lymph nodes ▪▪ Thorax: Ipsilateral axillary lymph nodes ▪▪ Upper limb: Ipsilateral epitrochlear and axillary lymph nodes ▪▪ Abdomen, loins, and buttocks: Ipsilateral inguinal lymph nodes ▪▪ Lower limb: Ipsilateral popliteal and inguinal lymph nodes ▪▪

Tumours in the Boundary Zones Between these sites The lymph nodes pertaining to the regions on both sides of the boundary zone are considered to be the regional lymph nodes.

The following 4‐cm wide bands are considered as boundary zones:

Between

Along

Right/left Head and neck/thorax

Midline Clavicula–acromion–upper shoulder blade edge Shoulder–axilla–shoulder Front: middle between navel and costal arch Back: lower border of thoracic vertebrae (midtransverse axis) Groin–trochanter–gluteal Sulcus

Thorax/upper limb Thorax/abdomen, loins, and buttocks

Abdomen, loins, and buttock/lower limb

Any metastasis to other than the listed regional lymph nodes is consid­ ered as M1.