title: The need for a better prognostic staging system in patients with metastatic cutaneous squamous cell carcinoma of the head and neck.
abstract: OBJECTIVE
  A validated and universal staging system for metastatic cutaneous head and neck squamous cell carcinoma that accurately describes its clinical behaviour is vital for prognostication and management. The current clinical staging system is not specific for the head and neck and makes no allowances for disease extent. The lack of an improved staging system prevents any meaningful research into improved treatment strategies in patients with head and neck cutaneous squamous cell carcinoma.
  
  
  RESULTS
  Contemporary evidence supports surgery and adjuvant radiotherapy as current best practice for patients with operable metastatic head and neck cutaneous squamous cell carcinoma. Despite this, patients with poor-prognosis disease are still at risk of locoregional relapse and may benefit from collaborative research. The modified staging system proposed by O'Brien is an important aspect of any further research and is discussed in this article.
  
  
  CONCLUSIONS
  The present clinical staging for head and neck cutaneous squamous cell carcinoma is inadequate and the evidence to date supports a recommendation for changing the current system to reflect the heterogeneity and complexity of this disease.
authors.affiliation: Head and Neck Cancer Service, Westmead Hospital, University of Sydney, Australia. carsten_palme@wsahs.nsw.gov.au
authors.forename: Carsten E
authors.initials: CE
authors.lastname: Palme
authors.forename: Stuart G
authors.initials: SG
authors.lastname: MacKay
authors.forename: Ian
authors.initials: I
authors.lastname: Kalnins
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Morgan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Veness
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000556:secondary; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000556:secondary; D006801:Humans; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D012878:Skin Neoplasms / Q000473:pathology