(Excludes Eyelid, Vulva, and Penis; excludes
Melanoma)
MACROSCOPIC (check all that apply)
___ Elipse
___ Shavings
___
Curettings
___ Other (specify:____________)
TUMOR SITE:
_______________
TUMOR SIZE: ___ (x___x___) cm
TUMOR FEATURES
___ Raised
___ Flat
___ Ulcerated
___ Unpigmented
___ Pigmented
___ Necrosis
___ Hemorrhage
___ Indeterminate
MICROSCOPIC (check all that apply)
EPIDERMAL CARCINOMAS
___ Basal cell carcinoma (BCC)
___
Superficial BCC
___
Nodular BCC (solid, adenoid cystic)
___
Infiltrating BCC
___
Sclerosing BCC (desmoplastic, morpheic)
___
Fibroepithelial BCC
___ BCC
with adnexal differentiation
___ Follicular BCC
___ Eccrine BCC
___
Basosquamous carcinoma
___
Keratotic BCC
___
Pigmented BCC
___ BCC in
basal cell nevus syndrome
___
Squamous cell carcinoma
___
Spindle-cell (sarcomatoid) SCC
___
Acantholytic SCC
___
Verrucous SCC
___ SCC
with horn formation
___
Lymphoepithelial SCC
___
Papillary SCC
___ Clear-cell
SCC
___
Small-cell SCC
___
Post-traumatic (e.g., "Marjolin's ulcer")
___
Metaplastic ("carcinosarcomatous") SCC
___
Paget’s Disease
___
Mammary Paget’s disease
___
Extramammary Paget’s disease
___
Adnexal carcinoma
___
Eccrine carcinoma
___
Sclerosing sweat duct carcinoma (syringomatous carcinoma, microcystic adnexal
carcinoma)
___
Malignant mixed tumor of the skin (malignant chondroid syringoma)
___
Porocarcinoma
___
Malignant nodular hidradenoma
___
Malignant eccrine spiradenoma
___
Mucinous eccrine carcinoma
___
Adenoid cystic eccrine carcinoma
___
Aggressive digital papillary adenoma/adenocarcinoma
___
Apocrine carcinoma
___
Sebaceous carcinoma
___
Tricholemmocarcinoma
___
Malignant pilomatricoma (matrical carcinoma)
___ Merkel
cell carcinoma
___ Mitotic activity <10 division
figures per 10 high power
___
Mitotic activity ³10
division figures per 10 high power
HISTOLOGIC
GRADE
___ GX: Cannot be assessed
___ G1:
Well differentiated
___ G2:
Moderately differentiated
___ G3-4: Poorly differentiated/undifferentiated
___ Not applicable
EXTENT OF
INVASION
PRIMARY TUMOR (T)
___ TX Primary
tumor cannot be assessed
___ T0 No
evidence of primary tumor
___ Tis Carcinoma
in situ
___ T1 Tumor
< 2 cm in greatest dimension
___ T1a -
limited to dermis or < 2 mm in thickness
___ T1b -
limited to dermis and > 2 mm in thickness but < 6 mm in thickness
___ T1c -
invading the subcutis and/or > 6 mm in thickness
___ T2 Tumor
> 2 cm but < 5 cm in greatest dimension
___ T2a -
limited to dermis or < 2 mm in thickness
___ T2b -
limited to dermis and > 2 mm in thickness but £ 6 mm in thickness
___ T2c -
invading the subcutis and/or > 6 mm in thickness
___ T3 Tumor
> 5 cm in greatest dimension
___ T3a -
limited to dermis or < 2 mm in thickness
___ T3b -
limited to dermis and > 2 mm in thickness but < 6 mm in thickness
___ T3c -
invading the subcutis and/or > 6 mm in thickness
___ T4 Tumor
invades the deep extradermal tissue (eg, bone, cartilage, muscle)
___ T4a - <
6 mm in thickness
___ T4b -
> 6 mm in thickness
REGIONAL LYMPH NODES (N)
___ NX Regional
lymph nodes cannot be assessed
___ N0 No
regional lymph node metastasis
___ N1 Regional
lymph node metastasis
DISTANT METASTASIS (M)
___ MX Presence
of distant metastasis cannot be assessed
___ M0 No
distant metastasis
___ M1 Distant
metastasis
___ Margins uninvolved by tumor
Distance of tumor from
closest margin: __ cm
(Specify margin:
________________)
___ Margin(s) involved by tumor
(Specify margin:
________________)
BLOOD/LYMPHATIC
VESSEL INVASION
___ Absent
___ Present
___
Indeterminate (see comment)
PERINEURAL
INVASION
___ Absent
___ Present
___
Indeterminate (see comment)
ADDITIONAL PATHOLOGIC FINDINGS
___
Actinic keratosis
___
Bowen's disease
___ Other (specify)
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