title: Distant metastases from cutaneous squamous cell carcinoma--analysis of AJCC stage IV.
abstract: BACKGROUND
  The seventh edition of the American Joint Committee on Cancer (AJCC) Staging Manual introduced a more detailed system to stage regional lymph node metastases for disease with cutaneous squamous cell carcinoma (SCC). The purpose of this study was to determine if the inclusion of disease staged N2 and N3 together with disease staged M1 is an appropriate grouping within stage IV.
  
  
  METHODS
  A retrospective multicenter analysis was conducted of 603 patients with metastatic cutaneous SCC to compare survival data for regional (N2 and N3) versus distant metastases.
  
  
  RESULTS
  Disease specific survival (DSS) and overall survival (OS) were much poorer for patients with distant disease compared to those with different stages of regional disease. After 5 years, only 25% of patients with N2 disease and 35% of patients with N3 disease died from their cancer compared with 89% of patients with distant metastases.
  
  
  CONCLUSIONS
  Our results indicate that in cutaneous SCC, stage IV represents a very heterogeneous group. Therefore, N2 and N3 disease should not be grouped with M1 together within AJCC stage IV.
authors.affiliation: Sydney Head and Neck Cancer Institute, The Sydney Cancer Centre, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales, 2050 Sydney, Australia. drbrunner@web.de
authors.forename: Markus
authors.initials: M
authors.lastname: Brunner
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Veness
authors.forename: Sydney
authors.initials: S
authors.lastname: Ch'ng
authors.forename: Michael
authors.initials: M
authors.lastname: Elliott
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Clark
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000556:secondary*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology*; D016019:Survival Analysis; D015996:Survival Rate