Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The Brigham and Women's Hospital tumor staging calculator for cutaneous squamous cell carcinoma identifies tumor severity based on specific clinical characteristics. These characteristics include:

- Tumor diameter of 2 cm or more
- Poorly differentiated histologic characteristics
- Perineural invasion
- Tumor invasion beyond the subcutaneous fat, excluding bone invasion
- Bone invasion

Each characteristic's presence is assessed as a 'yes' or 'no' (boolean). Based on the following predefined scoring system, each present characteristic contributes to the total score:

- Tumor diameter >= 2 cm: 1 point
- Poorly differentiated histologic characteristics: 1 point
- Perineural invasion: 1 point
- Tumor invasion beyond the subcutaneous fat (excluding bone invasion): 1 point
- Bone invasion: 4 points

Once the presence of these characteristics is determined, the calculator computes a total score by adding the individual scores. This total score, ranging from 0 to 8, is used to categorize the tumor stage as follows:

| Score | Interpretation |
|-------|----------------|
| 0     | T1             |
| 1     | T2a            |
| 2     | T2b            |
| 3     | T2b            |
| 4-8   | T3             |

A score of 0 indicates a T1 stage, representing the least severe case with no risk factors present. A score of 1 corresponds to a T2a stage, denoting one risk factor. Scores of 2 or 3 fall under the T2b stage, signifying moderate tumor advancement. Scores from 4 to 8 designate a T3 stage, indicating a severe tumor condition due to higher-risk aspects such as bone invasion. The stages reflect increasing levels of tumor aggressiveness and potential treatment challenges.

The Brigham and Women's Hospital (BWH) Tumor Staging System for Cutaneous Squamous Cell Carcinoma is a clinical calculator used to stage cutaneous squamous cell carcinoma (cSCC), a type of skin cancer. This system is specifically applicable to patients diagnosed with cSCC. 

The BWH staging system provides a more detailed stratification of tumor risk compared to other staging systems, such as the American Joint Committee on Cancer (AJCC) system. It takes into account factors such as tumor diameter, depth of invasion, perineural invasion, and location, among others. 

The clinical utility of this calculator lies in its ability to predict patient outcomes, guide treatment decisions, and facilitate communication between clinicians. It helps in identifying high-risk tumors that may require more aggressive treatment and closer follow-up.

There are no specific exclusion criteria for the use of the BWH staging system. However, it may not be as useful in cases where the tumor characteristics do not align with the factors considered in this system. For instance, it may not be as effective in staging cSCC arising from unusual sites or in the context of genetic syndromes.

Brigham and Women's Hospital tumor staging for cutaneous squamous cell carcinoma

The system evaluates the TNM classification for nonmelanoma cutaneous carcinomas of the head and neck region, excluding Merkel cell carcinoma, by taking three inputs related to the tumor, lymph nodes, and metastasis:

1. Tumor Classification (T): 
   - Tx: Primary tumor cannot be assessed
   - T0: No evidence of primary tumor
   - Tis: Carcinoma in situ
   - T1: Tumor <= 2 cm in greatest dimension
   - T2: Tumor > 2 cm but <= 4 cm in greatest dimension
   - T3: Tumor > 4 cm in maximum dimension or minor bone erosion or perineural invasion or deep invasion
   - T4a: Tumor with gross cortical bone/marrow invasion
   - T4b: Tumor with skull base invasion and/or skull base foramen involvement

2. Lymph Node Classification (N):
   - Nx: Regional lymph nodes cannot be assessed
   - N0: No regional lymph node metastasis
   - N1: Metastasis in a single ipsilateral lymph node, <= 3 cm in greatest dimension and no extranodal extension
   - N2a: Metastasis in single ipsilateral lymph node > 3 cm but <= 6 cm in greatest dimension and no extranodal extension
   - N2b: Metastasis in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and no extranodal extension
   - N2c: Metastasis in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and no extranodal extension
   - N3a: Metastasis in a lymph node > 6 cm in greatest dimension and no extranodal extension
   - N3c: Metastasis in any node with extranodal extension

3. Metastasis Classification (M):
   - M0: No distant metastasis
   - M1: Distant metastasis present

The system computes a result based on these inputs which categorizes the stage of carcinoma. Here is the output description based on a set of logical conditions:

- Stage 0: Defined if the tumor is carcinoma in situ (Tis), with no regional lymph node metastasis (N0), and no distant metastasis (M0).
- Stage I: Defined if the tumor is <= 2 cm in greatest dimension (T1), with no regional lymph node metastasis (N0), and no distant metastasis (M0).
- Stage II: Defined if the tumor is > 2 cm but <= 4 cm in greatest dimension (T2), with no regional lymph node metastasis (N0), and no distant metastasis (M0).
- Stage III: Defined if the tumor is > 4 cm with conditions of T3 or includes certain lymph node involvement (N1) but no distant metastasis (M0).
- Stage IV: Defined through various pathologic criteria including significant lymph node involvement (N2 or N3 categories), tumor invasion extent (T4 stages), or the presence of distant metastasis (M1). It encompasses different combinations incorporating any degree of lymph node or tumor staging along with either local progression or distant spread.

The calculator in question is the TNM Classification for Nonmelanoma Cutaneous Carcinomas of the Head and Neck Region, excluding Merkel Cell Carcinoma. TNM stands for Tumor, Node, Metastasis, a system used to classify the extent of cancer spread. This specific TNM classification applies to patients with nonmelanoma skin cancers located in the head and neck region, such as basal cell carcinoma and squamous cell carcinoma.

The clinical utility of this calculator is to stage the cancer, which is crucial for determining the appropriate treatment strategy and predicting patient prognosis. The TNM classification takes into account the size and extent of the primary tumor (T), whether the cancer has spread to nearby lymph nodes (N), and whether it has metastasized, or spread to other parts of the body (M).

Exclusion criteria for this calculator include patients with Merkel cell carcinoma, a rare and aggressive type of skin cancer, as it has its own specific TNM classification. Additionally, this calculator is not applicable to melanoma skin cancers or non-skin cancers of the head and neck region.

TNM classification for nonmelanoma cutaneous carcinomas of the head and neck region (except Merkel cell carcinoma)

The Eastern Cooperative Oncology Group (ECOG) performance status calculator is designed to evaluate a patient's functional ability and categorize it into a specific score from 0 to 5. This quantitative measure helps clinicians make informed decisions about treatment based on the patient's capacity for daily activities and self-care. Here's how it operates:

The user provides input by selecting the description that best matches the patient's current condition from a list of predefined options. These options encapsulate various levels of activity and ability:

- A patient who is "Fully active, able to carry on all pre-disease performance without restriction" is assigned a score of ECOG PS 0. This indicates that the patient is not limited in any capacity by their disease.
- If a patient is "Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, such as light housework, office work," they receive an ECOG PS 1. This means the patient can perform some self-care and work activities but faces restrictions with strenuous tasks.
- "Ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking hours" corresponds to an ECOG PS 2. This reflects moderate impairment, where the patient is active for the majority of the day but not capable of work activities.
- A patient who is "Capable of only limited self-care, confined to bed or chair more than 50% of waking hours" gets an ECOG PS 3. This score denotes significant limitation, as the patient is mobile for less than 50% of the time and requires assistance for most activities.
- With "Completely disabled, cannot carry on any self-care, totally confined to bed or chair," the patient is categorized as ECOG PS 4, indicating severe impairment and complete dependency.
- Finally, if the patient is "Dead," they are assigned an ECOG PS 5.

These score assignments help standardize assessments, providing an objective measure of a patient's status which can be pivotal in guiding medical decisions and evaluating treatment options.

The Eastern Cooperative Oncology Group (ECOG) performance status, also known as the ECOG score, is a widely used tool in oncology to assess a patient's level of functioning in terms of their ability to care for themselves, daily activity, and physical ability (walking, working, etc.). It is applicable to patients with cancer of any type and at any stage.

The ECOG score ranges from 0 to 5, with 0 indicating fully active and able to carry on all pre-disease activities without restriction, and 5 indicating death. The score is used to determine a patient's prognosis, assess how a disease is progressing, and to determine appropriate treatment strategies. It is also often used in clinical trials to assess eligibility and to monitor patient progress.

There are no specific exclusion criteria for the use of the ECOG score, but it is important to note that it is a subjective measure and may not fully capture a patient's functional status. It is also less useful in patients with fluctuating or rapidly changing conditions.

Eastern Cooperative Oncology Group performance status (ECOG score)

The Karnofsky Performance Scale (KPS) provides a practical method to evaluate a patient's functional ability and the extent of care required based on their health status. The scale ranges from 0% to 100%, where higher percentages signify better functional capacity and health.

This tool involves selecting a descriptive statement that best reflects a patient's current condition from a predefined list. Each statement is connected to a specific KPS percentage that indicates the patient’s ability to perform daily activities and their dependency levels. Here’s how the assessment works:

- When a patient is described as "Normal, no complaints, no evidence of disease," this is assessed as KPS 100%. At this level, the individual can engage in all regular activities, including work, without needing special care.

- If a patient can "carry on normal activity" but exhibits "minor signs or symptoms of disease," they are scored at KPS 90%, indicating the capability to maintain routine activities without requiring special care.

- A description of "Normal activity with effort, some signs or symptoms of disease" aligns with KPS 80%. This suggests the patient can still carry out normal activities but might require some extra effort.

- When the condition reflects "Cares for self, unable to carry on normal activity or to do active work," it corresponds to KPS 70%. The patient can handle most personal needs independently but may need occasional assistance.

- "Requires occasional assistance but is able to care for most personal needs" is rated as KPS 60%, implying increased dependency on assistance though the patient remains mostly self-sufficient.

- At KPS 50%, for conditions described as "Requires considerable assistance and frequent medical care," the patient can live at home but needs considerable help with personal care.

- As the need for care intensifies, with descriptions like "Disabled, requires special care and assistance," the KPS drops to 40%. This marks a significant deterioration in self-care ability.

- "Severely disabled, hospital admission is indicated, death not imminent" corresponds to KPS 30%, highlighting a need for hospitalization without immediate life-threatening conditions.

- For those "Very sick," necessitating hospital admission and "active supportive treatment," the KPS is 20%, indicating critical care requirements.

- At KPS 10%, "Moribund" denotes an inability to care for oneself, with urgent need for hospital-level care and a poor prognosis.

- Lastly, "Dead" is considered as KPS 0%.

This scale is instrumental in providing a quick overview of a patient's ability to function independently and their need for medical support, thereby facilitating better care planning and resource allocation.

The Karnofsky Performance Status Scale (KPSS) is a clinical calculator used primarily in patients with cancer. It is a simple, numerical scale that measures a patient's functional status, ability to perform daily activities, and overall quality of life. The KPSS ranges from 0 (indicating death) to 100 (indicating perfect health). 

The clinical utility of the KPSS is to assess a patient's prognosis, determine appropriate treatment strategies, and monitor changes in a patient's condition over time. It is particularly useful in oncology for determining eligibility for certain treatments, such as chemotherapy or surgery, and for predicting survival outcomes. 

There are no specific exclusion criteria for the use of the KPSS. However, it is less useful in patients with non-cancer illnesses or in those with cognitive impairment who may not be able to accurately self-report their functional status.

Karnofsky Performance Scale

The Modified Glasgow Prognostic Score (mGPS) is a key tool in predicting cancer outcomes, relying on the assessment of two biochemical markers: C-reactive protein (CRP) and albumin. This score helps to categorize the prognosis into three levels: good, intermediate, and poor.

To compute the mGPS:

- C-reactive protein is evaluated first. Two options are considered:  
  - If the CRP is less than or equal to 10 mg/L, it indicates lower systemic inflammation.
  - If the CRP is greater than 10 mg/L, it signifies higher inflammation levels.

- Albumin is the second marker, with two possibilities:  
  - An albumin level of less than 3.5 g/dL [35 g/L] suggests malnutrition or potential inflammatory conditions.
  - An albumin level equal to or greater than 3.5 g/dL [35 g/L] signifies a normal nutritional status and protein reserves.

The mGPS score is derived based on the following systematic interpretation:

- If CRP is <= 10 mg/L, regardless of the albumin level, the score is mGPS 0, corresponding to a good prognosis. This combination indicates a low level of inflammation, which is a favorable signal in cancer outcomes.
 
- If CRP is > 10 mg/L and albumin is >= 3.5 g/dL [35 g/L], the score is mGPS 1, associated with an intermediate prognosis. This combination suggests elevated inflammation yet with sufficient nutritional status, resulting in a moderate outlook.

- If CRP is > 10 mg/L and albumin is < 3.5 g/dL [35 g/L], the result is mGPS 2, indicating a poor prognosis. This reflects high inflammation levels coupled with low albumin, suggesting a more severe condition.

Here's a concise summary table for reference:

| C-reactive Protein | Albumin               | mGPS Score | Interpretation          |
|---------------------|-----------------------|-------------|-----------------------|
| <= 10 mg/L          | < 3.5 or >= 3.5 g/dL  | 0           | Good prognosis         |
| > 10 mg/L           | >= 3.5 g/dL           | 1           | Intermediate prognosis |
| > 10 mg/L           | < 3.5 g/dL            | 2           | Poor prognosis         |

This systematic approach enables healthcare providers to improve risk stratification in cancer patients, allowing for more tailored treatment planning.

The Modified Glasgow Prognostic Score (mGPS) is a clinical calculator used in the field of oncology to predict the prognosis of patients with cancer. It is applicable to a wide range of cancer types and stages, making it a versatile tool for clinicians. The mGPS is based on two simple, routinely measured inflammatory markers: C-reactive protein (CRP) and albumin levels. 

The clinical utility of the mGPS lies in its ability to stratify patients into different risk groups based on their inflammatory response to cancer. This can guide clinicians in making decisions about treatment strategies and follow-up plans. It can also provide valuable prognostic information to patients and their families.

There are no specific exclusion criteria for the use of the mGPS. However, it should be noted that the score may not be as accurate in patients with concurrent inflammatory or infectious conditions, as these can also affect CRP and albumin levels. Additionally, the mGPS may not be applicable to patients with rare types of cancer or those with very early or very advanced disease, as it has not been extensively validated in these groups.

Modified Glasgow Prognostic Score for cancer outcomes (mGPS)

Cutaneous squamous cell carcinoma

Management of local disease

Management of local disease, surgical excision

Pretreatment counseling

Management of locally advanced/metastatic disease

Management of locally advanced/metastatic disease, lymph node dissection, general principles

Management of local disease, wound closure

Physical examination

Management of locally advanced/metastatic disease, photodynamic therapy

Management of locally advanced/metastatic disease, adjuvant radiotherapy

Surveillance after curative-intent therapy

Management of locally advanced/metastatic disease (laser therapy)

Management of locally advanced/metastatic disease, surgical resection

Management of local disease, definitive radiotherapy

Management of local disease, curettage and cautery

Sentinel lymph node biopsy

Skin reconstruction after tumor resection

Skin reconstruction after tumor resection (perioperative analgesics)

Management of local disease, laser therapy

Skin biopsy

Management of locally advanced/metastatic disease, definitive radiotherapy

Management of local disease (elective lymph node dissection)

Management of locally advanced/metastatic disease, systemic therapy

Patients with keratoacanthoma

Management of local disease, Mohs micrographic surgery

Staging

Skin reconstruction after tumor resection (follow-up)

Management of locally advanced/metastatic disease, palliative care

Management of local disease, cryotherapy

Risk assessment

Surveillance for future malignancies

Management of locally advanced/metastatic disease, general principles

Indications for screening

Management of locally advanced/metastatic disease (lymph node dissection, non-head and neck region)

Management of local disease, topical therapies

Management of local disease, general principles

Skin reconstruction after tumor resection (perioperative antibiotics)

Management of local disease, photodynamic therapy

Skin reconstruction after tumor resection (perioperative antithrombotics)

Secondary prevention

Diagnostic imaging

Imaging for staging

Primary prevention

Primary prevention (EDA)

Management of local disease, adjuvant radiotherapy

Skin reconstruction after tumor resection (timing)

Management of locally advanced/metastatic disease (lymph node dissection, head and neck region)

Cutaneous squamous cell carcinoma

Guidelines

Key sources