Author Affiliation: Department of Dermatology, Johns Hopkins Hospital, Baltimore, Maryland.
Creating a staging system for cancer is not easy. The goal is to stratify patients based on the likelihood of developing an adverse event, most commonly metastasis or death. Groupings should be distinctive (the likelihood of developing the adverse event differs between groups), monotonous (the likelihood increases with increasing stage), and homogeneous (the likelihood is similar within each group).1 It has also been suggested that staging systems should be clinically relevant (no one grouping is too rarely or too frequently utilized) and parsimonious (all other things being equal, simpler is better).2 Finally, as suggested by Jambusaria-Pahlajani et al3 in this issue of the journal, in cancers like cutaneous squamous cell carcinoma (CSCC), in which the likelihood of metastasis and death is low, it is helpful if a staging system can “concentrate” those patients who are most likely to develop adverse events. This will allow testing and use of adjuvant interventions in those individuals for whom it is most appropriate.
Miller SJ. Staging Cutaneous Squamous Cell Carcinoma. JAMA Dermatol. 2013;149(4):472–474. doi:10.1001/jamadermatol.2013.2385