Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Lip - 1 Version 02.02.00
Lip, Upper
Lip (Vermilion or Labial Mucosa)
C00.0, C00.3 C00.0 External upper lip
C00.3 Mucosa of upper lip
Note: AJCC includes labial mucosa (C00.3) with buccal mucosa (C06.0)
CS Tumor Size CS Extension CS Tumor Size/Ext Eval CS Lymph Nodes CS Lymph Nodes Eval Reg LN Pos Reg LN Exam CS Mets at DX CS Mets Eval
CS Site-Specific Factor 1 Size of Lymph Nodes CS Site-Specific Factor 2 OBSOLETE -
Extracapsular Extension, Lymph Nodes for
Head and Neck CS Site-Specific Factor 3 Levels I-III, Lymph
Nodes for Head and Neck CS Site-Specific Factor 4 Levels IV-V and
Retropharyngeal Lymph Nodes for Head and
Neck CS Site-Specific Factor 5 Levels VI-VII and
Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 Parapharyngeal,
Parotid, and Suboccipital/Retroauricular Lymph
Nodes, Lymph Nodes for Head and Neck CS Site-Specific Factor 7 Upper and Lower
Cervical Node Levels CS Site-Specific Factor 8 Extracapsular
Extension Clinically, Lymph Nodes for Head
and Neck CS Site-Specific Factor 9 Extracapsular
Extension Pathologically, Lymph Nodes for
Head and Neck CS Site-Specific Factor 10 HPV (Human
Papilloma Virus) Status CS Site-Specific Factor 11 Measured Thickness
(Depth) CS Site-Specific Factor 12 CS Site-Specific Factor 13 CS Site-Specific Factor 14 CS Site-Specific Factor 15 CS Site-Specific Factor 16 CS Site-Specific Factor 17 CS Site-Specific Factor 18 CS Site-Specific Factor 19 CS Site-Specific Factor 20 CS Site-Specific Factor 21 CS Site-Specific Factor 22 CS Site-Specific Factor 23 CS Site-Specific Factor 24 CS Site-Specific Factor 25
The following tables are
available at the collaborative
staging website:
Histology Inclusion Table
AJCC 7th ed. Histology Exclusion Table
AJCC 6th ed. AJCC TNM 7 Stage AJCC TNM 6 Stage Summary Stage Extension Size Table Lymph Nodes Size Table
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 2 Version 02.02.00
Lip, Upper
CS Tumor Size (Revised: 10/18/2009) Note 1: Code the specific tumor size as stated in the medical record. Use code 992, 994, or 995 if the physician's
statement about T value is the ONLY information available about the size of the tumor. (Refer to the CS Extension
table for instructions on coding extension.)
Code Description
000 No mass/tumor found
001-988 001 - 988 millimeters (code exact size in millimeters)
989 989 millimeters or larger
990 Microscopic focus or foci only, no size of focus given
991 Described as "less than 1 cm"
992 Described as "less than 2 cm," or "greater than 1 cm," or "between 1 cm and 2 cm"
Stated as T1 with no other information on size
993 Described as "less than 3 cm," or "greater than 2 cm," or "between 2 cm and 3 cm"
994 Described as "less than 4 cm," or "greater than 3 cm," or "between 3 cm and 4 cm"
Stated as T2 with no other information on size
995 Described as "less than 5 cm," or "greater than 4 cm," or "between 4 cm and 5 cm"
Stated as T3 with no other information on size
996 Described as "greater than 5cm"
999 Unknown; size not stated
Not documented in patient record
Lip, Upper
CS Extension (Revised: 10/23/2009) Note 1: Periosteum is a fibrous membrane that wraps the outer surface of bones. Cortical bone is the dense
compact outer layer of bone. Trabecular, cancellous, or spongy bone (spongiosa) is a porous network of tissue filling
the interior of bone, decreasing weight and allowing room for blood vessels and marrow.
Note 2: AJCC assigns T value based on size when bone involvement is limited to the cortex. Involvement through
cortical bone is required for assignment of T4a.
Note 2: Use code 300 for localized tumor ONLY if no information is available to assign codes 100, 200, 405, 410,
or 415.
Note 3: Use code 405, 410, 415, 778, 810, or 815 if the physician's assignment of T category is the ONLY
information available for the extent of the tumor.
Code Description TNM 7 TNM 6 SS77 SS2000
000 In situ; noninvasive; intraepithelial Tis Tis IS IS
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 3 Version 02.02.00
Code Description TNM 7 TNM 6 SS77 SS2000
100 Invasive tumor confined to:
Labial mucosa (inner lip)
Lamina propria
Multiple foci
Submucosa (superficial invasion)
Vermilion surface
Superficial extension to:
Skin of lip
Subcutaneous soft tissue of lip
^ * L L
200 Musculature ^ * L L
300 Localized, NOS ^ * L L
405 Stated as T1 with no other information on extension ^ * L L
410 Stated as T2 with no other information on extension ^ * L L
415 Stated as T3 with no other information on extension ^ * L L
500 Buccal mucosa (inner cheek)
Commissure
Opposite (both) lip(s)
^ * RE RE
510 Upper gingiva Gingiva, NOS (Note: Lower gingiva
moved to code 780)
^ * RE RE
535 Cortical bone of maxilla
Cortical bone NOS (not specified in higher codes)
Bone, NOS (not specified in higher codes)
^ * RE RE
700 OBSOLETE DATA RETAINED V0200
Maxilla
ERROR T4a RE RE
725 Trabecular bone of maxilla T4a T4a RE RE
740 Nose T4a T4a RE D
750 Tongue T4a T4a D D
760 Skin of face/neck T4a T4a D D
770 OBSOLETE DATA RETAINED V0200
Cortical bone (other than code 700)
Floor of mouth
Inferior alveolar nerve
ERROR T4a D D
775 Floor of mouth
Inferior alveolar nerve
T4a T4a D D
778 Stated as T4a with no other information on extension T4a T4a RE RE
780 Lower gingiva T4b T4b D RE
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 4 Version 02.02.00
Code Description TNM 7 TNM 6 SS77 SS2000
785 780 + (740, 750, 760, or 775)
(Lower gingiva + any structure in 740, 750, 760, or
775)
T4b T4b D D
788 Bone of mandible
Mandible NOS
Specified bone (Other than maxilla, mandible, and
bones in codes 790 and 800)
T4b T4b D D
790 Masticator space
Pterygoid plates
T4b T4b D D
800 Further contiguous extension including:
Skull base
Internal carotid artery (encased)
T4b T4b D D
810 Stated as T4b with no other information on extension T4b T4b D D
815 Stated as T4 [NOS] with no other information on
extension
T4NOS T4NOS RE RE
950 No evidence of primary tumor T0 T0 U U
999 Unknown extension
Primary tumor cannot be assessed
Not documented in patient record
TX TX U U
^ For Extension codes 100 through 535 ONLY, the T category for AJCC 7th Edition staging is assigned based on
the value of CS Tumor Size, as shown in the Extension Size Table for this site.
* For Extension codes 100 through 535 ONLY, the T category for AJCC 6th Edition staging is assigned based on
the value of CS Tumor Size, as shown in the Extension Size Table for this site.
Lip, Upper
CS Tumor Size/Ext Eval (Revised: 08/10/2009)
Code Description Staging
Basis
0 Does not meet criteria for AJCC pathologic staging:
No surgical resection done. Evaluation based on physical examination, imaging
examination, or other non-invasive clinical evidence. No autopsy evidence used.
c
1 Does not meet criteria for AJCC pathologic staging:
No surgical resection done. Evaluation based on endoscopic examination, diagnostic
biopsy, including fine needle aspiration biopsy, or other invasive techniques, including
surgical observation without biopsy. No autopsy evidence used.
c
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 5 Version 02.02.00
Code Description Staging
Basis
2 Meets criteria for AJCC pathologic staging:
No surgical resection done, but evidence derived from autopsy (tumor was suspected or
diagnosed prior to autopsy)
p
3 Either criteria meets AJCC pathologic staging:
Surgical resection performed WITHOUT pre-surgical systemic treatment or radiation
OR surgical resection performed, unknown if pre-surgical systemic treatment or radiation
performed
AND Evaluation based on evidence acquired before treatment, supplemented or modified
by the additional evidence acquired during and from surgery, particularly from
pathologic examination of the resected specimen.
No surgical resection done. Evaluation based on positive biopsy of highest T classification.
p
5 Does not meet criteria for AJCC y-pathologic (yp) staging:
Surgical resection performed AFTER neoadjuvant therapy and tumor size/extension based
on clinical evidence, unless the pathologic evidence at surgery (AFTER neoadjuvant)
is more extensive (see code 6).
c
6 Meets criteria for AJCC y-pathologic (yp) staging:
Surgical resection performed AFTER neoadjuvant therapy AND tumor size/extension
based on pathologic evidence, because pathologic evidence at surgery is more
extensive than clinical evidence before treatment.
yp
8 Meets criteria for autopsy (a) staging:
Evidence from autopsy only (tumor was unsuspected or undiagnosed prior to autopsy)
a
9 Unknown if surgical resection done
Not assessed; cannot be assessed
Unknown if assessed
Not documented in patient record
c
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 6 Version 02.02.00
Lip, Upper
CS Lymph Nodes (Revised: 01/25/2010) Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by
AJCC. The complete definitions are provided in the General Instructions.
Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes,
extracapsular extension, levels involved, and location of involved nodes above or below the lower border of the
cricoid cartilage) is coded in Site-Specific Factors 1, 3-9.
Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered
ipsilateral.
Note 4: For head and neck cancers, if lymph nodes are described only as "supraclavicular", try to determine if they
are in Level IV (deep to the sternocleidomastoid muscle, in the lower jugular chain) or Level V (in the posterior
triangle, inferior to the transverse cervical artery) and code appropriately. If the specific level cannot be determined,
consider them as Level V nodes.
Note 5: The description of lymph nodes has been standardized across the head and neck schemas. All lymph node
levels and groups listed here are considered regional nodes for AJCC staging. Summary Stage 1977 and Summary
Stage 2000 divide these nodes into regional and distant groups.
Note 6: Level I nodes moved from code 110 in CSv1 to code 105.
Code Description TNM 7 TNM 6 SS77 SS2000
000 None; no regional lymph node involvement N0 N0 NONE NONE
100 Single positive ipsilateral regional node:
Other groups:
Facial:
Buccinator (buccal)
Nasolabial
Parotid
Infraauricular
Intraparotid
Periparotid
Preauricular
Regional lymph node, NOS
^ * RN RN
105 Single positive ipsilateral regional node:
Level 1A
Submental
Level IB
Submandibular (submaxillary)
^ * RN D
110 Single positive ipsilateral regional node:
Level II node - Upper jugular
Jugulodigastric (subdigastric)
Upper deep cervical
Level IIA
Level IIB
Level III node - Middle jugular
Middle deep cervical
Level IV node - Lower jugular
Jugulo-omohyoid (supraomohyoid)
Lower deep cervical
Virchow node
Cervical, NOS
Deep cervical, NOS
Internal jugular, NOS
^ * D RN
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 7 Version 02.02.00
Code Description TNM 7 TNM 6 SS77 SS2000
120 Single positive ipsilateral regional node:
Level V node
Posterior triangle group
Posterior cervical
Level VA - Spinal accessory
Level VB - Transverse cervical,
supraclavicular
Level VI node - Anterior compartment group
Laterotracheal
Paralaryngeal
Paratracheal - above suprasternal notch
Perithyroidal
Precricoid (Delphian)
Prelaryngeal
Pretracheal - above suprasternal notch
Recurrent laryngeal
Level VII node - Superior mediastinal group (for
other mediastinal nodes see CS Mets at DX)
Esophageal groove
Paratracheal - below suprasternal notch
Pretracheal - below suprasternal notch
Other groups:
Facial:
Mandibular
Parapharyngeal
Retroauricular
Retropharyngeal
Sublingual
Suboccipital
^ * D D
180 Stated as N1, no other information N1 N1 RN RN
190 Stated as N2a, no other information N2a N2a RN RN
200 Multiple positive ipsilateral nodes listed in code 100 ^ * RN RN
205 Multiple positive ipsilateral nodes, any listed in code
105 (WITH or WITHOUT nodes listed in code
100)
^ * RN D
210 Multiple positive ipsilateral nodes, any listed in code
110 (WITH or WITHOUT nodes listed in code
100)
^ * D RN
215 Multiple positive ipsilateral nodes listed in both codes
105 and 110 (WITH or WITHOUT nodes listed in
code 100)
^ * D D
220 Multiple positive ipsilateral nodes, any listed in code
120 (WITH or WITHOUT nodes listed in code
100, 105, or 110)
^ * D D
290 Stated as N2b, no other information N2b N2b RN RN
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 8 Version 02.02.00
Code Description TNM 7 TNM 6 SS77 SS2000
300 Regional lymph nodes listed in code 100:
Positive ipsilateral node(s), not stated if single or
multiple
^ * RN RN
305 Regional lymph nodes listed in code 105:
Positive ipsilateral node(s), not stated if single or
multiple
^ * RN D
310 Regional lymph nodes listed in code 110:
Positive ipsilateral node(s), not stated if single or
multiple
^ * D RN
320 Regional lymph nodes listed in code 120:
Positive ipsilateral node(s), not stated if single or
multiple
^ * D D
400 Regional lymph nodes listed in code 100:
Positive bilateral or contralateral nodes
^ * RN RN
405 Regional lymph nodes, any listed in code 105:
Positive bilateral or contralateral nodes (WITH or
WITHOUT nodes listed in code 100)
^ * RN D
410 Regional lymph nodes, any listed in code 110:
Positive bilateral or contralateral nodes (WITH or
WITHOUT nodes listed in code 100)
^ * D RN
415 Regional lymph nodes listed in both codes 105 and 110:
Positive bilateral or contralateral nodes (WITH or
WITHOUT nodes listed in code 100)
^ * D D
420 Regional lymph nodes, any listed in code 120:
Positive bilateral or contralateral nodes (WITH or
WITHOUT nodes listed in code 100, 105, or 110)
^ * D D
490 Stated as N2c, no other information N2c N2c RN RN
500 Regional lymph nodes listed in code 100:
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral,
AND not stated if single or multiple
^ * RN RN
505 Regional lymph nodes listed in code 105:
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral,
AND not stated if single or multiple
^ * RN D
510 Regional lymph nodes listed in code 110:
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral,
AND not stated if single or multiple
^ * D RN
520 Regional lymph nodes as listed in code 120:
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral,
AND not stated if single or multiple
^ * D D
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 9 Version 02.02.00
Code Description TNM 7 TNM 6 SS77 SS2000
600 Stated as N2, NOS N2NOS N2NOS RN RN
700 Stated as N3, no other information N3 N3 RN RN
800 Lymph nodes, NOS, no other information ^ * RN RN
999 Unknown; not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
NX NX U U
^ For codes 100-120, 200-220, 300-320, 400-420, 500-520, and 800 ONLY, the N category for AJCC 7th Edition
staging is assigned based on the value of Site-Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph
Nodes Size Table, for this site.
* For codes 100-120, 200-220, 300-320, 400-420, 500-520, and 800 ONLY, the N category for AJCC 6th Edition
staging is assigned based on the value of Site-Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph
Nodes Size Table, for this site.
Lip, Upper
CS Lymph Nodes Eval (Revised: 10/26/2009) Note 1: This field is used primarily to derive the staging basis for the N category in the TNM system. It records
how the code for the item "CS Lymph Nodes" was determined based on the diagnostic methods employed and their
intent.
Note 2: In the 7th edition of the AJCC manual, the clinical and pathologic classification rules for the N category were
changed to reflect current medical practice. The N is designated as clinical or pathologic based on the intent
(workup versus treatment) matching with the assessment of the T classification. When the intent is workup, the
staging basis is clinical, and when the intent is treatment, the staging basis is pathologic.
A. Microscopic assessment including biopsy of regional nodes or sentinel nodes if being performed as part of
the workup to choose the treatment plan, is therefore part of the clinical staging. When it is part of the workup, the
T category is clinical, and there has not been a resection of the primary site adequate for pathologic T classification
(which would be part of the treatment).
B. Microscopic assessment of regional nodes if being performed as part of the treatment is therefore part of the
pathologic staging. When it is part of the treatment, the T category is pathologic, and there has been a resection of
the primary site adequate for pathologic T classification (all part of the treatment).
Note 3: Microscopic assessment of the highest N category is always pathologic (code 3).
Note 4: If lymph node dissection is not performed after neoadjuvant therapy, use code 0 or 1.
Note 5: Only codes 5 and 6 are used if the node assessment is performed after neoadjuvant therapy.
Code Description Staging
Basis
0 Does not meet criteria for AJCC pathologic staging:
No regional lymph nodes removed for examination. Evidence based on physical
examination, imaging examination, or other non-invasive clinical evidence. No
autopsy evidence used.
c
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 10 Version 02.02.00
Code Description Staging
Basis
1 Does not meet criteria for AJCC pathologic staging based on at least one of the following
criteria:
No regional lymph nodes removed for examination. Evidence based on endoscopic
examination, or other invasive techniques including surgical observation, without
biopsy. No autopsy evidence used.
OR
Fine needle aspiration, incisional core needle biopsy, or excisional biopsy of regional
lymph nodes or sentinel nodes as part of the diagnostic workup, WITHOUT removal
of the primary site adequate for pathologic T classification (treatment).
c
2 Meets criteria for AJCC pathologic staging:
No regional lymph nodes removed for examination, but evidence derived from autopsy
(tumor was suspected or diagnosed prior to autopsy).
p
3 Meets criteria for AJCC pathologic staging based on at least one of the following criteria:
Any microscopic assessment of regional nodes (including FNA, incisional core needle bx,
excisional bx, sentinel node bx or node resection), WITH removal of the primary site
adequate for pathologic T classification (treatment) or biopsy assessment of the highest
T category.
OR
Any microscopic assessment of a regional node in the highest N category, regardless of the
T category information.
p
5 Does not meet criteria for AJCC y-pathologic (yp) staging:
Regional lymph nodes removed for examination AFTER neoadjuvant therapy AND lymph
node evaluation based on clinical evidence, unless the pathologic evidence at surgery
(AFTER neoadjuvant) is more extensive (see code 6).
c
6 Meets criteria for AJCC y-pathologic (yp) staging:
Regional lymph nodes removed for examination AFTER neoadjuvant therapy AND lymph
node evaluation based on pathologic evidence, because the pathologic evidence at
surgery is more extensive than clinical evidence before treatment.
yp
8 Meets criteria for AJCC autopsy (a) staging:
Evidence from autopsy; tumor was unsuspected or undiagnosed prior to autopsy.
a
9 Unknown if lymph nodes removed for examination
Not assessed; cannot be assessed
Unknown if assessed
Not documented in patient record
c
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 11 Version 02.02.00
Lip, Upper
Reg LN Pos (Revised: 03/30/2009) Note: Record this field even if there has been preoperative treatment.
Code Description
00 All nodes examined negative.
01-89 1 - 89 nodes positive (code exact number of nodes positive)
90 90 or more nodes positive
95 Positive aspiration or core biopsy of lymph node(s)
97 Positive nodes - number unspecified
98 No nodes examined
99 Unknown if nodes are positive; not applicable
Not documented in patient record
Lip, Upper
Reg LN Exam (Revised: 03/02/2009)
Code Description
00 No nodes examined
01-89 1 - 89 nodes examined (code exact number of regional lymph nodes examined)
90 90 or more nodes examined
95 No regional nodes removed, but aspiration or core biopsy of regional nodes performed
96 Regional lymph node removal documented as sampling and number of nodes unknown/not stated
97 Regional lymph node removal documented as dissection and number of nodes unknown/not stated
98 Regional lymph nodes surgically removed but number of lymph nodes unknown/not stated and not
documented as sampling or dissection; nodes examined, but number unknown
99 Unknown if nodes were examined; not applicable or negative
Not documented in patient record
Lip, Upper
CS Mets at DX (Revised: 07/23/2009) Note: Supraclavicular and transverse cervical lymph nodes are coded in CS Lymph Nodes because they are
categorized as N rather than M in AJCC TNM.
Code Description TNM 7 TNM 6 SS77 SS2000
00 No; none M0 M0 NONE NONE
10 Distant lymph node(s)
Mediastinal
Distant lymph node(s), NOS
M1 M1 D D
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29 April 2010 Part II - Lip - 12 Version 02.02.00
Code Description TNM 7 TNM 6 SS77 SS2000
40 Distant metastases except distant lymph node(s)(code
10)
Carcinomatosis
M1 M1 D D
50 (10) + (40)
Distant lymph node(s) plus other distant metastases
M1 M1 D D
60 Distant metastasis, NOS
Stated as M1, NOS
M1 M1 D D
99 Unknown if distant metastasis
Distant metastasis cannot be assessed
Not documented in patient record
M0 MX U U
Lip, Upper
CS Mets Eval (Revised: 08/10/2009) Note: This item reflects the validity of the classification of the item CS Mets at DX only according to the
diagnostic methods employed.
Code Description Staging
Basis
0 Does not meet criteria for AJCC pathologic staging of distant metastasis:
Evaluation of distant metastasis based on physical examination, imaging examination,
and/or other non-invasive clinical evidence. No pathologic examination of metastatic
tissue performed or pathologic examination was negative.
c
1 Does not meet criteria for AJCC pathologic staging of distant metastasis:
Evaluation of distant metastasis based on endoscopic examination or other invasive
technique, including surgical observation without biopsy. No pathologic examination
of metastatic tissue performed or pathologic examination was negative.
c
2 Meets criteria for AJCC pathologic staging of distant metastasis:
No pathologic examination of metastatic specimen done prior to death, but positive
metastatic evidence derived from autopsy (tumor was suspected or diagnosed prior to
autopsy).
p
3 Meets criteria for AJCC pathologic staging of distant metastasis:
Specimen from metastatic site microscopically positive WITHOUT pre-surgical systemic
treatment or radiation
OR specimen from metastatic site microscopically positive, unknown if pre-surgical
systemic treatment or radiation performed
OR specimen from metastatic site microscopically positive prior to neoadjuvant treatment.
p
5 Does not meet criteria for AJCC y-pathologic (yp) staging of distant metastasis:
Specimen from metastatic site microscopically positive WITH pre-surgical systemic
treatment or radiation, BUT metastasis based on clinical evidence.
c
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 13 Version 02.02.00
Code Description Staging
Basis
6 Meets criteria for AJCC y-pathologic (yp) staging of distant metastasis:
Specimen from metastatic site microscopically positive WITH pre-surgical systemic
treatment or radiation, BUT metastasis based on pathologic evidence.
yp
8 Meets criteria for AJCC autopsy (a) staging of distant metastasis:
Evidence from autopsy based on examination of positive metastatic tissue AND tumor was
unsuspected or undiagnosed prior to autopsy.
a
9 Not assessed; cannot be assessed
Unknown if assessed
Not documented in patient record
c
Lip, Upper
CS Site-Specific Factor 1 Size of Lymph Nodes (Revised: 12/01/2009) Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph
node(s). Do not code the size of any nodes coded in CS Mets at DX.
Code Description
000 No involved regional nodes
001-979 001-979 millimeters (code exact size in millimeters)
980 980 millimeters or larger
981-988 OBSOLETE DATA CONVERTED V0200
See code 980
981-988 millimeters
989 OBSOLETE DATA CONVERTED V0200
See code 980
989 millimeters or larger
990 Microscopic focus or foci only, no size of focus given
991 Described as "less than 1cm"
992 Described as "less than 2cm" or "greater than 1cm" or "between 1cm and 2cm"
993 Described as "less than 3cm" or "greater than 2cm" or "between 2cm and 3cm"
994 Described as "less than 4cm" or "greater than 3cm" or "between 3cm and 4cm"
995 Described as "less than 5cm" or "greater than 4cm" or "between 4cm and 5cm"
996 Described as "less than 6cm" or "greater than 5cm" or "between 5cm and 6cm"
997 Described as "more than 6cm"
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 14 Version 02.02.00
Code Description
999 Regional lymph node(s) involved, size not stated
Unknown if regional lymph node(s) involved
Not documented in patient record
Lip, Upper
CS Site-Specific Factor 2 OBSOLETE - Extracapsular Extension, Lymph Nodes for Head
and Neck (Revised: 12/30/2009) Note 1: This CS Site-Specific Factor is obsolete beginning with CS Version 2 (codes and notes). Old data are
retained, but new cases are not coded with this Factor. Use code 988 for this field.
Note 2: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved
regional lymph node(s) coded in the CS Lymph Nodes field. Do not code extracapsular extension in any nodes
coded in CS Mets at DX in this field.
Note 3: A statement of the presence or absence of extracasular extension in a pathology report takes priority over
clinical assessment. However, if the pathology report contains no statement about extracapsular extension, either
positive or negative, the clinical assessment should be coded. If nodes are involved but there is neither a clinical
assessment of extranodal extension nor a statement about it in the pathology report, use code 999.
Note 4: According to AJCC (page 24), "Imaging studies showing amorphous speculated margins of involved nodes
or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular
(extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such
disease."
Note 5: CS Site-Specific Factor 2 is obsolete beginning with CS Version 2 (codes and notes). Old data are retained,
but new cases are not coded with this Factor. Use code 988 for this field.
Code Description
000 OBSOLETE DATA RETAINED V0200
No extracapsular extension
001 OBSOLETE DATA RETAINED V0200
Extracapsular extension clinically, not assessed pathologically
Nodes described as "fixed", not assessed pathologically
005 OBSOLETE DATA RETAINED V0200
Extracapsular extension present pathologically
888 OBSOLETE DATA CONVERTED V0200
See code 987
Not applicable; no lymph node involvement
987 OBSOLETE DATA CONVERTED AND RETAINED V0200
Data converted from code 888
Not applicable; no lymph node involvement
988 Not applicable:
Information not collected for this case
999 OBSOLETE DATA RETAINED V0200
Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 15 Version 02.02.00
Lip, Upper
CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck (Revised: 03/30/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Code Description
000 No lymph node involvement in Levels I, II, or III
100 Level I lymph node(s) involved
010 Level II lymph node(s) involved
001 Level III lymph node(s) involved
110 Level I and II lymph nodes involved
101 Level I and III lymph nodes involved
011 Level II and III lymph nodes involved
111 Level I, II and III lymph nodes involved
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Lip, Upper
CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and
Neck (Revised: 03/30/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Code Description
000 No lymph node involvement in Levels IV or V or retropharyngeal
100 Level IV lymph node(s) involved
010 Level V lymph node(s) involved
001 Retropharyngeal nodes involved
110 Level IV and V lymph nodes involved
101 Level IV and retropharyngeal nodes involved
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29 April 2010 Part II - Lip - 16 Version 02.02.00
Code Description
011 Level V and retropharyngeal nodes involved
111 Level IV and V and retropharyngeal lymph nodes involved
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Lip, Upper
CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck (Revised:
03/30/2009) Note 1: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Note 2: Facial nodes including buccinator, mandibular, and nasolabial lymph nodes.
Code Description
000 No lymph node involvement in Levels VI or VII or facial nodes
100 Level VI lymph node(s) involved
010 Level VII lymph node(s) involved
001 Facial lymph node(s) involved
110 Level VI and VII lymph nodes involved
101 Level VI and facial nodes involved
011 Level VII and facial nodes involved
111 Level VI and VII and facial lymph nodes involved
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Lip - 17 Version 02.02.00
Lip, Upper
CS Site-Specific Factor 6 Parapharyngeal, Parotid, and Suboccipital/Retroauricular
Lymph Nodes, Lymph Nodes for Head and Neck (Revised: 08/25/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Code Description
000 No involvement of any group:
Parapharyngeal lymph nodes
Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes
Suboccipital/retroauricular lymph nodes
100 Parapharyngeal lymph node(s) involved
010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved
001 Suboccipital/retroauricular lymph node(s) involved
110 Involvement of two groups:
Parapharyngeal lymph nodes
Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes
101 Involvement of two groups:
Parapharyngeal lymph nodes
Suboccipital/retroauricular lymph nodes
011 Involvement of two groups:
Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes
Suboccipital lymph nodes
111 Involvement of three groups:
Parapharyngeal lymph nodes
Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes
, Suboccipital/retroauricular lymph nodes
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Lip - 18 Version 02.02.00
Lip, Upper
CS Site-Specific Factor 7 Upper and Lower Cervical Node Levels (Revised: 03/30/2009) Note 1: AJCC requires that nodes be designated as involving upper or lower levels within the neck. The boundary
between upper and lower levels is the lower border of the cricoid cartilage.
Note 2: Nodes in Levels I, II, and III are upper level nodes. Nodes in Level IV and VII are lower level nodes.
Level VA nodes are upper level nodes, and Level VB are lower level nodes. Level VI nodes span both upper and
lower levels. Nodes included in "Other groups" (Facial, Parotid, Parapharyngeal, Retropharyngeal, Retroauricular,
and Suboccipital) are all upper level nodes.
Note 3: Code the location of nodal involvement in relation to the lower border of the cricoid cartilage of all
involved nodes, whether assessed clinically or pathologically, as stated by a physician.
Note 4: If there is no physician statement of upper and/or lower level nodal involvement, assign levels I, II, III, and
VA nodes to upper level. Assign level IV, VB, and VII to lower level. If Level V (A and B not specified) and/or
Level VI nodes are involved with no further information about location, use code 040.
Note 5: A description of "mid neck" requires clarification with the physician. Code 040, unknown level, if "mid
neck" is the only information available.
Code Description
000 No lymph nodes involved
010 Upper level lymph nodes involved (all involved nodes above the lower border of the cricoid cartilage)
020 Lower level lymph nodes involved (all involved nodes below the lower border of the cricoid cartilage)
030 Upper and lower level lymph nodes involved (all involved nodes both above and below the lower
border of the cricoid cartilage)
040 Unknown level lymph nodes involved (unable to determine if involved nodes above or below the lower
border of the cricoid cartilage)
988 Not applicable:
Information not collected for this case
999 Unknown if regional lymph node(s) involved, not stated Not documented in patient record
Lip, Upper
CS Site-Specific Factor 8 Extracapsular Extension Clinically, Lymph Nodes for Head and
Neck (Revised: 10/16/2009) Note 1: Code the status of extracapsular extension accessed clinically for any involved regional lymph node(s)
coded in the CS Lymph Nodes field. Do not code extracapsular extensio in any nodes coded in CS Mets at DX in
this field.
Note 2: If nodes are involved clinically, and documentation of physical examination or imaging is available
without a statement of extracapsular extension, use code 010.
Note 3: If the only documentation is a reference to clinically involved nodes with no reference to extracapsular
extension, use code 030.
Note 4: If there is no information about clinical assessment of nodes, use code 999.
Note 5: Clinical assessment can be by physical examination or imaging. According to AJCC, "ECS can be
diagnosed clinically by a matted mass of nodes adherent to overlying skin, adjacent soft tissue, or clinical evidence
of cranial nerve tissue. Radiologic signs of ECS include amorphous, spiculated margins of a metastatic node and
stranding of the perinodal soft tissue in previously untreated patients."
Code Description
000 No lymph nodes involved clinically
010 Nodes involved clinically, no extracapsular extension clinically
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The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Lip - 19 Version 02.02.00
Code Description
020 Nodes involved clinically, extracapsular extension clinically (nodes described as fixed or matted)
030 Nodes involved clinically, unknown if extracapsular extension
988 Not applicable:
Information not collected for this case
997 Clinical examination of lymph nodes performed, unknown results
998 No clinical examination of lymph nodes
999 Unknown if regional lymph node(s) involved clinically, not stated Regional lymph nodes cannot be
accessed Not documented in patient record
Lip, Upper
CS Site-Specific Factor 9 Extracapsular Extension Pathologically, Lymph Nodes for Head
and Neck (Revised: 08/25/2009) Note 1: Code the status of extracapsular extension assessed pathologically of any involved regional lymph node(s)
coded in the CS Lymph Nodes field. Do not code extracapsular extension in any nodes coded in CS Mets at DX in
this field.
Note 2: If nodes are involved pathologically but there is no statement of extranodal extension in the pathology
report, use code 010.
Note 3: Code "microscopic" or "macroscropic" extranodal extension as stated in the final diagnosis. If not stated in
the final diagnosis, code "microscopic" if extranodal extension is described only in the microscopic section of the
pathology report and "macroscopic" if extranodal extension is described in the gross section of the pathology report.
Note 4: "Macroscopic" extension takes priority over "microscopic" extension.
Note 5: Use code 040 if pathologic extracapsular extension is described with no further information and the
pathology report is not available for review.
Note 6: Use code 050 if nodes involved pathologically with no further information about extracapsular extension.
Code Description
000 No lymph nodes involved pathologically
010 Nodes involved pathologically, no extracapsular extension pathologically
020 Nodes involved pathologically, MICROSCOPIC extracapsular extension pathologically
030 Nodes involved pathologically, MACROSCOPIC extracapsular extension pathologically
040 Nodes involved pathologically, extracapsular extension pathologically, unknown if microscopic or
macroscopic
050 Nodes involved pathologically, unknown if extracapsular extension
988 Not applicable:
Information not collected for this case
997 Pathologic examination of lymph nodes performed, results not available
998 No pathologic examination of lymph nodes
999 Unknown if regional lymph node(s) involved pathologically, not stated
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Lip - 20 Version 02.02.00
Lip, Upper
CS Site-Specific Factor 10 HPV (Human Papilloma Virus) Status (Revised: 10/12/2009) Note 1: There is evidence that human papilloma virus (HPV) plays a role in the pathogenesis of some cancers.
Note 2: Record the results of any HPV testing performed on pathologic specimens from the primary tumor or a
metastatic site, including regional nodes. HPV testing may be performed for prognostic purposes; testing may also
be performed on metastatic sites to aid in the determination of the primary site.
Note 3: The highest risk HPV types are types 16 and 18. Other high risk types are 31, 33, 35, 36, 45, 51, 52, 56, 58,
59, 68, 26, 53, 66, 67, 69, 70, 73, 82, 85 Low risk types are 6, 11, 32, 34, 40, 42, 44, 54, 61, 62, 64, 71, 72, 74, 81,
83, 84, 87, 89. The HPV vaccine is designed to protect against types 16 and 18 (associated with cervical cancer) and
types 6 and 11 (associated with genital warts).
Note 4: High risk may be abbreviated "hrHPV" or "HR-HPV".
Note 5: Some tests for HPV, such as a hybrid capture test, only report negative or positive for high risk HPV
without identifying types; use codes 025 and 050, respectively to report those test results.
Code Description
000 HPV test negative; not positive for any HPV types
Negative, NOS
010 LOW RISK positive (all positive type(s) are low risk)
020 HIGH RISK positive, specified type(s) other than types 16 or 18,
WITH or WITHOUT positive results for low risk type(s)
030 HIGH RISK positive for HPV 16 WITHOUT positive results for HPV 18 or positivity of HPV 18
unknown,
WITH or WITHOUT positive results for other high-risk types,
WITH or WITHOUT positive results for low risk type(s)
040 HIGH RISK positive for HPV 18 WITHOUT positive results for HPV 16 or positivity of HPV 16
unknown,
WITH or WITHOUT positive results for other high-risk types,
WITH or WITHOUT positive results for low risk type(s)
050 HIGH RISK positive for HPV 16 AND HPV 18,
WITH or WITHOUT positive results for other high-risk types,
WITH or WITHOUT positive results for low risk type(s)
060 HIGH RISK positive, NOS, type(s) not specified
070 Positive, NOS, risk and type(s) not stated
988 Not applicable:
Information not collected for this case
997 Test ordered, results not in chart
998 Test not done (test was not ordered and was not performed), including no pathologic specimen
available for HPV testing
999 Unknown or no information
Not documented in patient record
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Lip - 21 Version 02.02.00
Lip, Upper
CS Site-Specific Factor 11 Measured Thickness (Depth) (Revised: 11/15/2009) Note 1: Code MEASURED THICKNESS (Depth) of the invasive tumor not size, diameter, or any other
measurement. Record the actual measurement in tenths of millimeters as stated on the pathology repot. Do not
record the measurement from a radiographic report.
Note 2: Record the measurement labeled specifically as thickness or depth of tumor. In the absence of a label,use
the "cut surface" dimension, or the third dimension from a description of 3 dimensions (N1 x N2 x N3). For
example, from a tumor size recorded as 2cm x 1cm x 0.5cm, record 050.
Code Description
000 No mass/tumor found
001-979 Exact thickness in tenths of millimeters
Examples:
001 0.1 millimeter
010 1 millimeter
042 4.2 millimeters
100 10 millimeters, 1 centimeter
103 10.3 millimeters
980 98.0 millimeters or larger
987 Not applicable, in situ carcinoma
988 Not applicable:
Information not collected for this case
990 Microinvasion
Microscopic focus or foci only; no depth given
998 No surgical specimen
999 Not documented in patient record
Unknown, thickness not stated
Lip, Upper
CS Site-Specific Factor 12 (Revised: 06/30/2008)
Code Description
988 Not applicable for this schema
Lip, Upper
CS Site-Specific Factor 13 (Revised: 06/30/2008)
Code Description
988 Not applicable for this schema
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Lip - 22 Version 02.02.00
Lip, Upper
CS Site-Specific Factor 14 (Revised: 06/30/2008)
Code Description
988 Not applicable for this schema
Lip, Upper
CS Site-Specific Factor 15 (Revised: 06/30/2008)
Code Description
988 Not applicable for this schema
Lip, Upper
CS Site-Specific Factor 16 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Lip, Upper
CS Site-Specific Factor 17 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Lip, Upper
CS Site-Specific Factor 18 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Lip, Upper
CS Site-Specific Factor 19 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Lip, Upper
CS Site-Specific Factor 20 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Lip - 23 Version 02.02.00
Lip, Upper
CS Site-Specific Factor 21 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Lip, Upper
CS Site-Specific Factor 22 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Lip, Upper
CS Site-Specific Factor 23 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Lip, Upper
CS Site-Specific Factor 24 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Lip, Upper
CS Site-Specific Factor 25 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Lip - 24 Version 02.02.00
Malignant Melanoma of Upper Lip
Lip (Vermilion or Labial Mucosa)
C00.0, C00.3 (M-8720-8790)
C00.0 External upper lip
C00.3 Mucosa of upper lip
Note: AJCC includes labial mucosa (C00.3) with buccal mucosa (C06.0)
CS Tumor Size CS Extension CS Tumor Size/Ext Eval CS Lymph Nodes CS Lymph Nodes Eval Reg LN Pos Reg LN Exam CS Mets at DX CS Mets Eval
CS Site-Specific Factor 1 Size of Lymph Nodes CS Site-Specific Factor 2 OBSOLETE -
Extracapsular Extension, Lymph Nodes for
Head and Neck CS Site-Specific Factor 3 Levels I-III, Lymph
Nodes for Head and Neck CS Site-Specific Factor 4 Levels IV-V and
Retropharyngeal Lymph Nodes for Head and
Neck CS Site-Specific Factor 5 Levels VI-VII and
Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 Parapharyngeal,
Parotid, and Suboccipital/Retroauricular Lymph
Nodes, Lymph Nodes for Head and Neck CS Site-Specific Factor 7 Upper and Lower
Cervical Node Levels CS Site-Specific Factor 8 Extracapsular
Extension Clinically, Lymph Nodes for Head
and Neck CS Site-Specific Factor 9 Extracapsular
Extension Pathologically, Lymph Nodes for
Head and Neck CS Site-Specific Factor 10 HPV (Human
Papilloma Virus) Status CS Site-Specific Factor 11 Measured Thickness
(Depth) CS Site-Specific Factor 12 CS Site-Specific Factor 13 CS Site-Specific Factor 14 CS Site-Specific Factor 15 CS Site-Specific Factor 16 CS Site-Specific Factor 17 CS Site-Specific Factor 18 CS Site-Specific Factor 19 CS Site-Specific Factor 20 CS Site-Specific Factor 21 CS Site-Specific Factor 22 CS Site-Specific Factor 23 CS Site-Specific Factor 24 CS Site-Specific Factor 25
The following tables are
available at the collaborative
staging website:
Histology Inclusion Table
AJCC 7th ed. Histology Exclusion Table
AJCC 6th ed. AJCC TNM 7 Stage AJCC TNM 6 Stage Summary Stage
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Lip - 25 Version 02.02.00
Malignant Melanoma of Upper Lip
CS Tumor Size (Revised: 02/03/2010)
Code Description
000 No mass/tumor found
001-988 001 - 988 millimeters (code exact size in millimeters)
989 989 millimeters or larger
990 Microscopic focus or foci only and no size of focus given
991 Described as "less than 1 cm"
992 Described as "less than 2 cm," or "greater than 1 cm," or "between 1 cm and 2 cm"
993 Described as "less than 3 cm," or "greater than 2 cm," or "between 2 cm and 3 cm"
994 Described as "less than 4 cm," or "greater than 3 cm," or "between 3 cm and 4 cm"
995 Described as "less than 5 cm," or "greater than 4 cm," or "between 4 cm and 5 cm"
999 Unknown; size not stated
Not documented in patient record
Malignant Melanoma of Upper Lip
CS Extension (Revised: 01/04/2010) Note 1: AJCC does not include a Tis or TX category for melanoma of mucosa of head and neck sites. Extension codes of
000 and 999 will be mapped to NA and AJCC stage group will be derived as NA.
Note 2: AJCC does not include a T1 or T2 category for mucosal melanoma of head and neck sites.
Note 3: Use code 300 for localized tumor ONLY if no information is available to assign code 105 or 470.
Note 4: Use code 470, 775, 810, or 815 if the physician's assignment of T category is the ONLY information
available about the extent of the tumor.
Code Description TNM 7 TNM 6 SS77 SS2000
000 In situ; noninvasive; intraepithelial NA NA IS IS
100 OBSOLETE DATA RETAINED V0200
Invasive tumor confined to:
Labial mucosa (inner lip)
Lamina propria
Multiple foci
Submucosa (superficial invasion)
Vermilion surface
Superficial extension to:
Skin of lip
Subcutaneous soft tissue of lip
ERROR NA L L
105 Tumor confined to mucosa of upper lip:
Labial mucosa (inner lip)
Vermilion surface
T3 NA L L
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 26 Version 02.02.00
Code Description TNM 7 TNM 6 SS77 SS2000
200 OBSOLETE DATA CONVERTED V0200
See code 520
Musculature
ERROR ERROR ERROR ERROR
300 Localized, NOS T3 NA L L
400 Extension via mucosa to:
Inner cheek (buccal mucosa)
Commissure
Opposite (both) lip(s)
T3 NA RE RE
410 Extension via mucosa to:
Upper gingiva
Gingiva NOS
T3 NA RE RE
440 Extension via mucosa to lower gingiva T3 NA D RE
450 Extension via mucosa to:
Floor of mouth
Tongue
T3 NA D D
470 Stated as T3 with no other information on extension T3 NA L L
500 OBSOLETE DATA RETAINED V0200
Buccal mucosa (inner cheek)
Commissure
Opposite (both) lip(s)
ERROR NA RE RE
510 OBSOLETE DATA RETAINED V0200
Gingiva
ERROR NA RE RE
520 Involvement of deep soft tissue or musculature of upper
lip
Soft tissue NOS
T4a NA L L
530 520 + (400 or 410)
(Involvement of deep soft tissue or musculature of
upper lip + Mucosal involvement of any structure
in code 400 or 410)
T4a NA RE RE
540 Involvement of deep soft tissue or musculature of any
structure in code 400
T4a NA RE RE
550 Involvement of deep tissue or periosteum of upper
gingiva
T4a NA RE RE
700 Cartilage of maxilla
Cartilage NOS
Cortical bone of maxilla
Cortical bone NOS
Maxilla, NOS
Bone NOS except skull base
T4a NA RE RE
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 27 Version 02.02.00
Code Description TNM 7 TNM 6 SS77 SS2000
705 (520, 540, or 700) + 440
(Any structure in code 520 or 540 + Mucosa of lower
gingiva)
T4a NA D RE
710 Deep tissue or periosteum of lower gingiva T4a NA D RE
740 Skin of nose T4a NA RE D
743 740 + (440 or 710)
(Skin of nose + Mucosa or deep tissue lower gingiva)
T4a NA D D
745 (520, 540, 700, 710, or 740) + 450
(Any structure in code 520, 540, 700, 710, or 740 +
Mucosa of floor of mouth or tongue)
T4a NA D D
748 Involvement of deep tissue or musculature of floor of
mouth or tongue
Inferior alveolar nerve
T4a NA D D
750 OBSOLETE DATA RETAINED V0200
Tongue
ERROR NA D D
755 Extrinsic muscle of tongue
Genioglossus
Hyoglossus
Palatoglossus
Styloglossus
T4a NA D D
760 Skin of face/neck T4a NA D D
765 Cartilage of mandible
Cortical bone of mandible
Mandible NOS
T4a NA D D
770 OBSOLETE DATA RETAINED V0200
Cartilage of mandible
Cortical bone of mandible
Floor of mouth
Inferior alveolar nerve
ERROR NA D D
775 Stated as T4a with no other information on extension T4a NA L L
790 Contiguous extension:
Masticator space
Pterygoid plates
Skull base
Internal carotid artery (encased)
T4b NA D D
800 OBSOLETE DATA RETAINED V0200
Further contiguous extension
ERROR NA D D
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Lip - 28 Version 02.02.00
Code Description TNM 7 TNM 6 SS77 SS2000
801 Further contiguous extension:
Brain
Dura
Lower cranial nerves (IX, X, XI, XII)
Prevertebral space
Mediastinal structures
T4b NA D D
810 Stated as T4b with no other information on extension T4b NA D D
815 Stated as T4NOS with no other information on
extension
T4NOS NA L L
950 OBSOLETE DATA RETAINED V0200
No evidence of primary tumor
ERROR NA U U
999 Unknown extension
Primary tumor cannot be assessed
Not documented in patient record
NA NA U U
Malignant Melanoma of Upper Lip
CS Tumor Size/Ext Eval (Revised: 11/13/2009)
Code Description Staging
Basis 7
Staging
Basis 6
0 Does not meet criteria for AJCC pathologic staging:
No surgical resection done. Evaluation based on physical examination,
imaging examination, or other non-invasive clinical evidence. No autopsy
evidence used.
c
1 Does not meet criteria for AJCC pathologic staging:
No surgical resection done. Evaluation based on endoscopic examination,
diagnostic biopsy, including fine needle aspiration biopsy, or other
invasive techniques, including surgical observation without biopsy. No
autopsy evidence used.
c
2 Meets criteria for AJCC pathologic staging:
No surgical resection done, but evidence derived from autopsy (tumor was
suspected or diagnosed prior to autopsy)
p
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Lip - 29 Version 02.02.00
Code Description Staging
Basis 7
Staging
Basis 6
3 Either criteria meets AJCC pathologic staging:
Surgical resection performed WITHOUT pre-surgical systemic treatment or
radiation
OR surgical resection performed, unknown if pre-surgical systemic treatment or
radiation performed
AND Evaluation based on evidence acquired before treatment, supplemented or
modified by the additional evidence acquired during and from surgery,
particularly from pathologic examination of the resected specimen.
No surgical resection done. Evaluation based on positive biopsy of highest T
classification.
p
5 Does not meet criteria for AJCC y-pathologic (yp) staging:
Surgical resection performed AFTER neoadjuvant therapy and tumor
size/extension based on clinical evidence, unless the pathologic evidence at
surgery (AFTER neoadjuvant) is more extensive (see code 6).
c
6 Meets criteria for AJCC y-pathologic (yp) staging:
Surgical resection performed AFTER neoadjuvant therapy AND tumor
size/extension based on pathologic evidence, because pathologic evidence
at surgery is more extensive than clinical evidence before treatment.
yp
8 Meets criteria for autopsy (a) staging:
Evidence from autopsy only (tumor was unsuspected or undiagnosed prior to
autopsy)
a
9 Unknown if surgical resection done
Not assessed; cannot be assessed
Unknown if assessed
Not documented in patient record
c
Malignant Melanoma of Upper Lip
CS Lymph Nodes (Revised: 12/26/2009) Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by
AJCC. The complete definitions are provided in the General Instructions.
Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes,
extracapsular extension, levels involved, and location of involved nodes above or below the lower border of the
cricoid cartilage) is coded in Site-Specific Factors 1, 3-9.
Note 3: For head and neck cancers, if lymph nodes are described only as "supraclavicular", try to determine if they
are in Level IV (deep to the sternocleidomastoid muscle, in the lower jugular chain) or Level V (in the posterior
triangle, inferior to the transverse cervical artery) and code appropriately. If the specific level cannot be determined,
consider them as Level V nodes.
Code Description TNM 7 TNM 6 SS77 SS2000
000 None; no regional lymph node involvement N0 NA NONE NONE
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Code Description TNM 7 TNM 6 SS77 SS2000
100 Positive regional node(s):
Buccinator (buccal)
Nasolabial
Parotid
Infraauricular
Intraparotid
Periparotid
Preauricular
Regional lymph node, NOS
N1 NA RN RN
105 Positive regional node(s):
Level 1A - Submental
Level 1B - Submandibular (submaxillary),
sublingual
N1 NA RN D
110 Positive regional node(s):
Level II node - Upper jugular
Jugulodigastric (subdigastric)
Upper deep cervical
Level IIA
Level IIB
Level III node - Middle jugular
Middle deep cervical
Level IV node - Lower jugular
Jugulo-omohyoid (supraomohyoid)
Lower deep cervical
Virchow node
Cervical, NOS
Deep cervical, NOS
Internal jugular, NOS
N1 NA D RN
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Code Description TNM 7 TNM 6 SS77 SS2000
120 Positive regional node(s):
Level V node - Posterior triangle group
Posterior cervical
Level VA - Spinal accessory
Level VB - Transverse cervical,
supraclavicular (see Note 3)
Level VI node - Anterior compartment group
Laterotracheal
Paralaryngeal
Paratracheal - above suprasternal notch
Perithyroidal
Precricoid (Delphian)
Prelaryngeal
Pretracheal - above suprasternal notch
Recurrent laryngeal
Level VII node - Superior mediastinal group
(for other mediastinal nodes see CS Mets at
DX)
Esophageal groove
Paratracheal - below suprasternal notch
Pretracheal - below suprasternal notch
Mandibular
Other groups
Parapharyngeal
Retroauricular (mastoid)
Retropharyngeal
Suboccipital
N1 NA D D
180 Stated as N1, no other information N1 NA RN RN
190 OBSOLETE DATA RETAINED V0200
Stated as N2a, no other information
ERROR NA RN RN
200 OBSOLETE DATA RETAINED V0200
Multiple positive ipsilateral nodes listed in code 100
ERROR NA RN RN
210 OBSOLETE DATA RETAINED V0200
Multiple positive ipsilateral nodes listed in code 110
ERROR NA D RN
220 OBSOLETE DATA RETAINED V0200
Multiple positive ipsilateral nodes, any listed in code
120
ERROR NA D D
290 OBSOLETE DATA RETAINED V0200
Stated as N2b, no other information
ERROR NA RN RN
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Code Description TNM 7 TNM 6 SS77 SS2000
300 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 100:
Positive ipsilateral node(s), not stated if single or
multiple
ERROR NA RN RN
310 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 110
Positive ipsilateral node(s), not stated if single or
multiple
ERROR NA D RN
320 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 120:
Positive ipsilateral node(s), not stated if single or
multiple
ERROR NA D D
400 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 100:
Positive bilateral or contralateral nodes
ERROR NA RN RN
410 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 110
Positive bilateral or contralateral nodes
ERROR NA D RN
420 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 120:
Positive bilateral or contralateral nodes
ERROR NA D D
490 OBSOLETE DATA RETAINED V0200
Stated as N2c, no other information
ERROR NA RN RN
500 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 100:
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral,
AND not stated if single or multiple
ERROR NA RN RN
510 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 110
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral
AND not stated if single or multiple
ERROR NA D RN
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Code Description TNM 7 TNM 6 SS77 SS2000
520 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 120:
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral,
AND not stated if single or multiple
ERROR NA D D
600 OBSOLETE DATA RETAINED V0200
Stated as N2, NOS
ERROR NA RN RN
700 OBSOLETE DATA RETAINED V0200
Stated as N3, no other information
ERROR NA RN RN
800 Lymph nodes, NOS, no other information N1 NA RN RN
999 Unknown; not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
NX NA U U
Malignant Melanoma of Upper Lip
CS Lymph Nodes Eval (Revised: 11/13/2009) Note 1: This field is used primarily to derive the staging basis for the N category in the TNM system. It records
how the code for the item "CS Lymph Nodes" was determined based on the diagnostic methods employed and their
intent.
Note 2: In the 7th edition of the AJCC manual, the clinical and pathologic classification rules for the N category were
changed to reflect current medical practice. The N is designated as clinical or pathologic based on the intent
(workup versus treatment) matching with the assessment of the T classification. When the intent is workup, the
staging basis is clinical, and when the intent is treatment, the staging basis is pathologic.
A. Microscopic assessment including biopsy of regional nodes or sentinel nodes if being performed as part of
the workup to choose the treatment plan, is therefore part of the clinical staging. When it is part of the workup, the
T category is clinical, and there has not been a resection of the primary site adequate for pathologic T classification
(which would be part of the treatment).
B. Microscopic assessment of regional nodes if being performed as part of the treatment is therefore part of the
pathologic staging. When it is part of the treatment, the T category is pathologic, and there has been a resection of
the primary site adequate for pathologic T classification (all part of the treatment).
Note 3: Microscopic assessment of the highest N category is always pathologic (code 3).
Note 4: If lymph node dissection is not performed after neoadjuvant therapy, use code 0 or 1.
Note 5: Only codes 5 and 6 are used if the node assessment is performed after neoadjuvant therapy.
Code Description Staging
Basis 7
Staging
Basis 6
0 Does not meet criteria for AJCC pathologic staging:
No regional lymph nodes removed for examination. Evidence based on
physical examination, imaging examination, or other non-invasive clinical
evidence. No autopsy evidence used.
c
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Code Description Staging
Basis 7
Staging
Basis 6
1 Does not meet criteria for AJCC pathologic staging based on at least one of the
following criteria:
No regional lymph nodes removed for examination. Evidence based on
endoscopic examination, or other invasive techniques including surgical
observation, without biopsy. No autopsy evidence used.
OR
Fine needle aspiration, incisional core needle biopsy, or excisional biopsy of
regional lymph nodes or sentinel nodes as part of the diagnostic workup,
WITHOUT removal of the primary site adequate for pathologic T
classification (treatment).
c
2 Meets criteria for AJCC pathologic staging:
No regional lymph nodes removed for examination, but evidence derived from
autopsy (tumor was suspected or diagnosed prior to autopsy).
p
3 Meets criteria for AJCC pathologic staging based on at least one of the
following criteria:
Any microscopic assessment of regional nodes (including FNA, incisional core
needle bx, excisional bx, sentinel node bx or node resection), WITH
removal of the primary site adequate for pathologic T classification
(treatment) or biopsy assessment of the highest T category.
OR
Any microscopic assessment of a regional node in the highest N category,
regardless of the T category information.
p
5 Does not meet criteria for AJCC y-pathologic (yp) staging:
Regional lymph nodes removed for examination AFTER neoadjuvant therapy
AND lymph node evaluation based on clinical evidence, unless the
pathologic evidence at surgery (AFTER neoadjuvant) is more extensive
(see code 6).
c
6 Meets criteria for AJCC y-pathologic (yp) staging:
Regional lymph nodes removed for examination AFTER neoadjuvant therapy
AND lymph node evaluation based on pathologic evidence, because the
pathologic evidence at surgery is more extensive than clinical evidence
before treatment.
yp
8 Meets criteria for AJCC autopsy (a) staging:
Evidence from autopsy; tumor was unsuspected or undiagnosed prior to
autopsy.
a
9 Unknown if lymph nodes removed for examination
Not assessed; cannot be assessed
Unknown if assessed
Not documented in patient record
c
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Malignant Melanoma of Upper Lip
Reg LN Pos (Revised: 03/30/2009) Note: Record this field even if there has been preoperative treatment.
Code Description
00 All nodes examined negative.
01-89 1 - 89 nodes positive (code exact number of nodes positive)
90 90 or more nodes positive
95 Positive aspiration or core biopsy of lymph node(s)
97 Positive nodes - number unspecified
98 No nodes examined
99 Unknown if nodes are positive; not applicable
Not documented in patient record
Malignant Melanoma of Upper Lip
Reg LN Exam (Revised: 03/02/2009)
Code Description
00 No nodes examined
01-89 1 - 89 nodes examined (code exact number of regional lymph nodes examined)
90 90 or more nodes examined
95 No regional nodes removed, but aspiration or core biopsy of regional nodes performed
96 Regional lymph node removal documented as sampling and number of nodes unknown/not stated
97 Regional lymph node removal documented as dissection and number of nodes unknown/not stated
98 Regional lymph nodes surgically removed but number of lymph nodes unknown/not stated and not
documented as sampling or dissection; nodes examined, but number unknown
99 Unknown if nodes were examined; not applicable or negative
Not documented in patient record
Malignant Melanoma of Upper Lip
CS Mets at DX (Revised: 11/07/2009) Note: Supraclavicular and transverse cervical lymph nodes are coded in CS Lymph Nodes because they are
categorized as N rather than M in AJCC TNM.
Code Description TNM 7 TNM 6 SS77 SS2000
00 No; none M0 NA NONE NONE
10 Distant lymph node(s)
Mediastinal
Distant lymph node(s), NOS
M1 NA D D
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Code Description TNM 7 TNM 6 SS77 SS2000
40 Distant metastases except distant lymph node(s)(code
10)
Carcinomatosis
M1 NA D D
50 10 + 40)
(Distant lymph node(s) + Other distant metastases)
M1 NA D D
60 Distant metastasis, NOS
Stated as M1, NOS
M1 NA D D
99 Unknown if distant metastasis
Distant metastasis cannot be assessed
Not documented in patient record
M0 NA U U
Malignant Melanoma of Upper Lip
CS Mets Eval (Revised: 11/13/2009) Note: This item reflects the validity of the classification of the item CS Mets at DX only according to the
diagnostic methods employed.
Code Description Staging
Basis 7
Staging
Basis 6
0 Does not meet criteria for AJCC pathologic staging of distant metastasis:
Evaluation of distant metastasis based on physical examination, imaging
examination, and/or other non-invasive clinical evidence. No pathologic
examination of metastatic tissue performed or pathologic examination was
negative.
c
1 Does not meet criteria for AJCC pathologic staging of distant metastasis:
Evaluation of distant metastasis based on endoscopic examination or other
invasive technique, including surgical observation without biopsy. No
pathologic examination of metastatic tissue performed or pathologic
examination was negative.
c
2 Meets criteria for AJCC pathologic staging of distant metastasis:
No pathologic examination of metastatic specimen done prior to death, but
positive metastatic evidence derived from autopsy (tumor was suspected or
diagnosed prior to autopsy).
p
3 Meets criteria for AJCC pathologic staging of distant metastasis:
Specimen from metastatic site microscopically positive WITHOUT pre-surgical
systemic treatment or radiation
OR specimen from metastatic site microscopically positive, unknown if pre-
surgical systemic treatment or radiation performed
OR specimen from metastatic site microscopically positive prior to neoadjuvant
treatment.
p
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Code Description Staging
Basis 7
Staging
Basis 6
5 Does not meet criteria for AJCC y-pathologic (yp) staging of distant metastasis:
Specimen from metastatic site microscopically positive WITH pre-surgical
systemic treatment or radiation, BUT metastasis based on clinical
evidence.
c
6 Meets criteria for AJCC y-pathologic (yp) staging of distant metastasis:
Specimen from metastatic site microscopically positive WITH pre-surgical
systemic treatment or radiation, BUT metastasis based on pathologic
evidence.
yp
8 Meets criteria for AJCC autopsy (a) staging of distant metastasis:
Evidence from autopsy based on examination of positive metastatic tissue AND
tumor was unsuspected or undiagnosed prior to autopsy.
a
9 Not assessed; cannot be assessed
Unknown if assessed
Not documented in patient record
c
Malignant Melanoma of Upper Lip
CS Site-Specific Factor 1 Size of Lymph Nodes (Revised: 12/01/2009) Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph
node(s). Do not code the size of any nodes coded in CS Mets at DX.
Code Description
000 No involved regional nodes
001-979 001-979 millimeters (code exact size in millimeters)
980 980 millimeters or larger
981-988 OBSOLETE DATA CONVERTED V0200
See code 980
981-988 millimeters
989 OBSOLETE DATA CONVERTED V0200
See code 980
989 millimeters or larger
990 Microscopic focus or foci only, no size of focus given
991 Described as "less than 1cm"
992 Described as "less than 2cm" or "greater than 1cm" or "between 1cm and 2cm"
993 Described as "less than 3cm" or "greater than 2cm" or "between 2cm and 3cm"
994 Described as "less than 4cm" or "greater than 3cm" or "between 3cm and 4cm"
995 Described as "less than 5cm" or "greater than 4cm" or "between 4cm and 5cm"
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Code Description
996 Described as "less than 6cm" or "greater than 5cm" or "between 5cm and 6cm"
997 Described as "more than 6cm"
999 Regional lymph node(s) involved, size not stated
Unknown if regional lymph node(s) involved
Not documented in patient record
Malignant Melanoma of Upper Lip
CS Site-Specific Factor 2 OBSOLETE - Extracapsular Extension, Lymph Nodes for Head
and Neck (Revised: 12/30/2009) Note 1: This CS Site-Specific Factor is obsolete beginning with CS Version 2 (codes and notes). Old data are
retained, but new cases are not coded with this Factor. Use code 988 for this field.
Note 2: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved
regional lymph node(s) coded in the CS Lymph Nodes field. Do not code extracapsular extension in any nodes
coded in CS Mets at DX in this field.
Note 3: A statement of the presence or absence of extracasular extension in a pathology report takes priority over
clinical assessment. However, if the pathology report contains no statement about extracapsular extension, either
positive or negative, the clinical assessment should be coded. If nodes are involved but there is neither a clinical
assessment of extranodal extension nor a statement about it in the pathology report, use code 999.
Note 4: According to AJCC (page 24), "Imaging studies showing amorphous speculated margins of involved nodes
or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular
(extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such
disease."
Note 5: CS Site-Specific Factor 2 is obsolete beginning with CS Version 2 (codes and notes). Old data are retained,
but new cases are not coded with this Factor. Use code 988 for this field.
Code Description
000 OBSOLETE DATA RETAINED V0200
No extracapsular extension
001 OBSOLETE DATA RETAINED V0200
Extracapsular extension clinically, not assessed pathologically
Nodes described as "fixed", not assessed pathologically
005 OBSOLETE DATA RETAINED V0200
Extracapsular extension present pathologically
888 OBSOLETE DATA CONVERTED V0200
See code 987
Not applicable; no lymph node involvement
987 OBSOLETE DATA CONVERTED AND RETAINED V0200
Data converted from code 888
Not applicable; no lymph node involvement
988 Not applicable:
Information not collected for this case
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Code Description
999 OBSOLETE DATA RETAINED V0200
Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Malignant Melanoma of Upper Lip
CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck (Revised: 03/30/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Code Description
000 No lymph node involvement in Levels I, II, or III
100 Level I lymph node(s) involved
010 Level II lymph node(s) involved
001 Level III lymph node(s) involved
110 Level I and II lymph nodes involved
101 Level I and III lymph nodes involved
011 Level II and III lymph nodes involved
111 Level I, II and III lymph nodes involved
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Malignant Melanoma of Upper Lip
CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and
Neck (Revised: 03/30/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Code Description
000 No lymph node involvement in Levels IV or V or retropharyngeal
100 Level IV lymph node(s) involved
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Code Description
010 Level V lymph node(s) involved
001 Retropharyngeal nodes involved
110 Level IV and V lymph nodes involved
101 Level IV and retropharyngeal nodes involved
011 Level V and retropharyngeal nodes involved
111 Level IV and V and retropharyngeal lymph nodes involved
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Malignant Melanoma of Upper Lip
CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck (Revised:
03/30/2009) Note 1: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Note 2: Facial nodes including buccinator, mandibular, and nasolabial lymph nodes.
Code Description
000 No lymph node involvement in Levels VI or VII or facial nodes
100 Level VI lymph node(s) involved
010 Level VII lymph node(s) involved
001 Facial lymph node(s) involved
110 Level VI and VII lymph nodes involved
101 Level VI and facial nodes involved
011 Level VII and facial nodes involved
111 Level VI and VII and facial lymph nodes involved
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
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Malignant Melanoma of Upper Lip
CS Site-Specific Factor 6 Parapharyngeal, Parotid, and Suboccipital/Retroauricular
Lymph Nodes, Lymph Nodes for Head and Neck (Revised: 08/25/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Code Description
000 No involvement of any group:
Parapharyngeal lymph nodes
Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes
Suboccipital/retroauricular lymph nodes
100 Parapharyngeal lymph node(s) involved
010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved
001 Suboccipital/retroauricular lymph node(s) involved
110 Involvement of two groups:
Parapharyngeal lymph nodes
Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes
101 Involvement of two groups:
Parapharyngeal lymph nodes
Suboccipital/retroauricular lymph nodes
011 Involvement of two groups:
Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes
Suboccipital lymph nodes
111 Involvement of three groups:
Parapharyngeal lymph nodes
Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes
, Suboccipital/retroauricular lymph nodes
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
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Malignant Melanoma of Upper Lip
CS Site-Specific Factor 7 Upper and Lower Cervical Node Levels (Revised: 03/30/2009) Note 1: AJCC requires that nodes be designated as involving upper or lower levels within the neck. The boundary
between upper and lower levels is the lower border of the cricoid cartilage.
Note 2: Nodes in Levels I, II, and III are upper level nodes. Nodes in Level IV and VII are lower level nodes.
Level VA nodes are upper level nodes, and Level VB are lower level nodes. Level VI nodes span both upper and
lower levels. Nodes included in "Other groups" (Facial, Parotid, Parapharyngeal, Retropharyngeal, Retroauricular,
and Suboccipital) are all upper level nodes.
Note 3: Code the location of nodal involvement in relation to the lower border of the cricoid cartilage of all
involved nodes, whether assessed clinically or pathologically, as stated by a physician.
Note 4: If there is no physician statement of upper and/or lower level nodal involvement, assign levels I, II, III, and
VA nodes to upper level. Assign level IV, VB, and VII to lower level. If Level V (A and B not specified) and/or
Level VI nodes are involved with no further information about location, use code 040.
Note 5: A description of "mid neck" requires clarification with the physician. Code 040, unknown level, if "mid
neck" is the only information available.
Code Description
000 No lymph nodes involved
010 Upper level lymph nodes involved (all involved nodes above the lower border of the cricoid cartilage)
020 Lower level lymph nodes involved (all involved nodes below the lower border of the cricoid cartilage)
030 Upper and lower level lymph nodes involved (all involved nodes both above and below the lower
border of the cricoid cartilage)
040 Unknown level lymph nodes involved (unable to determine if involved nodes above or below the lower
border of the cricoid cartilage)
988 Not applicable:
Information not collected for this case
999 Unknown if regional lymph node(s) involved, not stated Not documented in patient record
Malignant Melanoma of Upper Lip
CS Site-Specific Factor 8 Extracapsular Extension Clinically, Lymph Nodes for Head and
Neck (Revised: 10/16/2009) Note 1: Code the status of extracapsular extension accessed clinically for any involved regional lymph node(s)
coded in the CS Lymph Nodes field. Do not code extracapsular extensio in any nodes coded in CS Mets at DX in
this field.
Note 2: If nodes are involved clinically, and documentation of physical examination or imaging is available
without a statement of extracapsular extension, use code 010.
Note 3: If the only documentation is a reference to clinically involved nodes with no reference to extracapsular
extension, use code 030.
Note 4: If there is no information about clinical assessment of nodes, use code 999.
Note 5: Clinical assessment can be by physical examination or imaging. According to AJCC, "ECS can be
diagnosed clinically by a matted mass of nodes adherent to overlying skin, adjacent soft tissue, or clinical evidence
of cranial nerve tissue. Radiologic signs of ECS include amorphous, spiculated margins of a metastatic node and
stranding of the perinodal soft tissue in previously untreated patients."
Code Description
000 No lymph nodes involved clinically
010 Nodes involved clinically, no extracapsular extension clinically
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Code Description
020 Nodes involved clinically, extracapsular extension clinically (nodes described as fixed or matted)
030 Nodes involved clinically, unknown if extracapsular extension
988 Not applicable:
Information not collected for this case
997 Clinical examination of lymph nodes performed, unknown results
998 No clinical examination of lymph nodes
999 Unknown if regional lymph node(s) involved clinically, not stated Regional lymph nodes cannot be
accessed Not documented in patient record
Malignant Melanoma of Upper Lip
CS Site-Specific Factor 9 Extracapsular Extension Pathologically, Lymph Nodes for Head
and Neck (Revised: 08/25/2009) Note 1: Code the status of extracapsular extension assessed pathologically of any involved regional lymph node(s)
coded in the CS Lymph Nodes field. Do not code extracapsular extension in any nodes coded in CS Mets at DX in
this field.
Note 2: If nodes are involved pathologically but there is no statement of extranodal extension in the pathology
report, use code 010.
Note 3: Code "microscopic" or "macroscropic" extranodal extension as stated in the final diagnosis. If not stated in
the final diagnosis, code "microscopic" if extranodal extension is described only in the microscopic section of the
pathology report and "macroscopic" if extranodal extension is described in the gross section of the pathology report.
Note 4: "Macroscopic" extension takes priority over "microscopic" extension.
Note 5: Use code 040 if pathologic extracapsular extension is described with no further information and the
pathology report is not available for review.
Note 6: Use code 050 if nodes involved pathologically with no further information about extracapsular extension.
Code Description
000 No lymph nodes involved pathologically
010 Nodes involved pathologically, no extracapsular extension pathologically
020 Nodes involved pathologically, MICROSCOPIC extracapsular extension pathologically
030 Nodes involved pathologically, MACROSCOPIC extracapsular extension pathologically
040 Nodes involved pathologically, extracapsular extension pathologically, unknown if microscopic or
macroscopic
050 Nodes involved pathologically, unknown if extracapsular extension
988 Not applicable:
Information not collected for this case
997 Pathologic examination of lymph nodes performed, results not available
998 No pathologic examination of lymph nodes
999 Unknown if regional lymph node(s) involved pathologically, not stated
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Lip - 44 Version 02.02.00
Malignant Melanoma of Upper Lip
CS Site-Specific Factor 10 HPV (Human Papilloma Virus) Status (Revised: 10/12/2009) Note 1: There is evidence that human papilloma virus (HPV) plays a role in the pathogenesis of some cancers.
Note 2: Record the results of any HPV testing performed on pathologic specimens from the primary tumor or a
metastatic site, including regional nodes. HPV testing may be performed for prognostic purposes; testing may also
be performed on metastatic sites to aid in the determination of the primary site.
Note 3: The highest risk HPV types are types 16 and 18. Other high risk types are 31, 33, 35, 36, 45, 51, 52, 56, 58,
59, 68, 26, 53, 66, 67, 69, 70, 73, 82, 85 Low risk types are 6, 11, 32, 34, 40, 42, 44, 54, 61, 62, 64, 71, 72, 74, 81,
83, 84, 87, 89. The HPV vaccine is designed to protect against types 16 and 18 (associated with cervical cancer) and
types 6 and 11 (associated with genital warts).
Note 4: High risk may be abbreviated "hrHPV" or "HR-HPV".
Note 5: Some tests for HPV, such as a hybrid capture test, only report negative or positive for high risk HPV
without identifying types; use codes 025 and 050, respectively to report those test results.
Code Description
000 HPV test negative; not positive for any HPV types
Negative, NOS
010 LOW RISK positive (all positive type(s) are low risk)
020 HIGH RISK positive, specified type(s) other than types 16 or 18,
WITH or WITHOUT positive results for low risk type(s)
030 HIGH RISK positive for HPV 16 WITHOUT positive results for HPV 18 or positivity of HPV 18
unknown,
WITH or WITHOUT positive results for other high-risk types,
WITH or WITHOUT positive results for low risk type(s)
040 HIGH RISK positive for HPV 18 WITHOUT positive results for HPV 16 or positivity of HPV 16
unknown,
WITH or WITHOUT positive results for other high-risk types,
WITH or WITHOUT positive results for low risk type(s)
050 HIGH RISK positive for HPV 16 AND HPV 18,
WITH or WITHOUT positive results for other high-risk types,
WITH or WITHOUT positive results for low risk type(s)
060 HIGH RISK positive, NOS, type(s) not specified
070 Positive, NOS, risk and type(s) not stated
988 Not applicable:
Information not collected for this case
997 Test ordered, results not in chart
998 Test not done (test was not ordered and was not performed), including no pathologic specimen
available for HPV testing
999 Unknown or no information
Not documented in patient record
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Lip - 45 Version 02.02.00
Malignant Melanoma of Upper Lip
CS Site-Specific Factor 11 Measured Thickness (Depth) (Revised: 11/15/2009) Note 1: Code MEASURED THICKNESS (Depth) of the invasive tumor not size, diameter, or any other
measurement. Record the actual measurement in tenths of millimeters as stated on the pathology repot. Do not
record the measurement from a radiographic report.
Note 2: Record the measurement labeled specifically as thickness or depth of tumor. In the absence of a label,use
the "cut surface" dimension, or the third dimension from a description of 3 dimensions (N1 x N2 x N3). For
example, from a tumor size recorded as 2cm x 1cm x 0.5cm, record 050.
Code Description
000 No mass/tumor found
001-979 Exact thickness in tenths of millimeters
Examples:
001 0.1 millimeter
010 1 millimeter
042 4.2 millimeters
100 10 millimeters, 1 centimeter
103 10.3 millimeters
980 98.0 millimeters or larger
987 Not applicable, in situ carcinoma
988 Not applicable:
Information not collected for this case
990 Microinvasion
Microscopic focus or foci only; no depth given
998 No surgical specimen
999 Not documented in patient record
Unknown, thickness not stated
Malignant Melanoma of Upper Lip
CS Site-Specific Factor 12 (Revised: 06/30/2008)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Upper Lip
CS Site-Specific Factor 13 (Revised: 06/30/2008)
Code Description
988 Not applicable for this schema
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 46 Version 02.02.00
Malignant Melanoma of Upper Lip
CS Site-Specific Factor 14 (Revised: 06/30/2008)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Upper Lip
CS Site-Specific Factor 15 (Revised: 06/30/2008)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Upper Lip
CS Site-Specific Factor 16 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Upper Lip
CS Site-Specific Factor 17 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Upper Lip
CS Site-Specific Factor 18 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Upper Lip
CS Site-Specific Factor 19 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Upper Lip
CS Site-Specific Factor 20 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 47 Version 02.02.00
Malignant Melanoma of Upper Lip
CS Site-Specific Factor 21 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Upper Lip
CS Site-Specific Factor 22 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Upper Lip
CS Site-Specific Factor 23 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Upper Lip
CS Site-Specific Factor 24 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Upper Lip
CS Site-Specific Factor 25 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Lip - 48 Version 02.02.00
Lip, Lower
Lip (Vermilion or Labial Mucosa)
C00.1, C00.4, C00.6 C00.1 External lower lip
C00.4 Mucosa of lower lip
C00.6 Commissure of lip
Note: AJCC includes labial mucosa (C00.4) with buccal mucosa (C06.0)
CS Tumor Size CS Extension CS Tumor Size/Ext Eval CS Lymph Nodes CS Lymph Nodes Eval Reg LN Pos Reg LN Exam CS Mets at DX CS Mets Eval
CS Site-Specific Factor 1 Size of Lymph Nodes CS Site-Specific Factor 2 OBSOLETE -
Extracapsular Extension, Lymph Nodes for
Head and Neck CS Site-Specific Factor 3 Levels I-III, Lymph
Nodes for Head and Neck CS Site-Specific Factor 4 Levels IV-V and
Retropharyngeal Lymph Nodes for Head and
Neck CS Site-Specific Factor 5 Levels VI-VII and
Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 Parapharyngeal,
Parotid, and Suboccipital/Retroauricular Lymph
Nodes, Lymph Nodes for Head and Neck CS Site-Specific Factor 7 Upper and Lower
Cervical Node Levels CS Site-Specific Factor 8 Extracapsular
Extension Clinically, Lymph Nodes for Head
and Neck CS Site-Specific Factor 9 Extracapsular
Extension Pathologically, Lymph Nodes for
Head and Neck CS Site-Specific Factor 10 HPV (Human
Papilloma Virus) Status CS Site-Specific Factor 11 Measured Thickness
(Depth) CS Site-Specific Factor 12 CS Site-Specific Factor 13 CS Site-Specific Factor 14 CS Site-Specific Factor 15 CS Site-Specific Factor 16 CS Site-Specific Factor 17 CS Site-Specific Factor 18 CS Site-Specific Factor 19 CS Site-Specific Factor 20 CS Site-Specific Factor 21 CS Site-Specific Factor 22 CS Site-Specific Factor 23 CS Site-Specific Factor 24 CS Site-Specific Factor 25
The following tables are
available at the collaborative
staging website:
Histology Inclusion Table
AJCC 7th ed. Histology Exclusion Table
AJCC 6th ed. AJCC TNM 7 Stage AJCC TNM 6 Stage Summary Stage Extension Size Table Lymph Nodes Size Table
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 49 Version 02.02.00
Lip, Lower
CS Tumor Size (Revised: 10/18/2009) Note 1: Code the specific tumor size as stated in the medical record. Use code 992, 994, or 995 if the physician's
statement about T value is the ONLY information available about the size of the tumor. (Refer to the CS Extension
table for instructions on coding extension.)
Code Description
000 No mass/tumor found
001-988 001 - 988 millimeters (code exact size in millimeters)
989 989 millimeters or larger
990 Microscopic focus or foci only, no size of focus given
991 Described as "less than 1 cm"
992 Described as "less than 2 cm," or "greater than 1 cm," or "between 1 cm and 2 cm"
Stated as T1 with no other information on size
993 Described as "less than 3 cm," or "greater than 2 cm," or "between 2 cm and 3 cm"
994 Described as "less than 4 cm," or "greater than 3 cm," or "between 3 cm and 4 cm"
Stated as T2 with no other information on size
995 Described as "less than 5 cm," or "greater than 4 cm," or "between 4 cm and 5 cm"
Stated as T3 with no other information on size
996 Described as "greater than 5cm"
999 Unknown; size not stated
Not documented in patient record
Lip, Lower
CS Extension (Revised: 10/23/2009) Note 1: Periosteum is a fibrous membrane that wraps the outer surface of bones. Cortical bone is the dense
compact outer layer of bone.Trabecular, cancellous, or spongy bone (spongiosa) is a porous network of tissue filling
the interior of bone, decreasing weight and allowing room for blood vessels and marrow.
Note 2: AJCC assigns T value based on size when bone involvement is limited to the cortex. Involvement through
cortical bone is required for assignment of T4a.
Note 3: Use code 300 for localized tumor ONLY if no information is available to assign codes 100, 200, 405, 410,
or 415.
Note 4: Use code 405, 410, 415, 778, 810, or 815 if the physician's assignment of T category is the ONLY
information available about the extent of the tumor.
Code Description TNM 7 TNM 6 SS77 SS2000
000 In situ; noninvasive; intraepithelial Tis Tis IS IS
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 50 Version 02.02.00
Code Description TNM 7 TNM 6 SS77 SS2000
100 Invasive tumor confined to:
Labial mucosa (inner lip)
Lamina propria
Multiple foci
Submucosa (superficial invasion)
Vermilion surface
Superficial extension to:
Skin of lip
Subcutaneous soft tissue of lip
^ * L L
200 Musculature ^ * L L
300 Localized, NOS ^ * L L
405 Stated as T1 with no other information on extension ^ * L L
410 Stated as T2 with no other information on extension ^ * L L
415 Stated as T3 with no other information on extension ^ * L L
500 Buccal mucosa (inner cheek)
Commissure (from lower lip only)
Opposite (both) lip(s)
^ * RE RE
510 Lower gingiva
Gingiva, NOS
Upper gingiva (from commissure only)
(Note: Upper gingiva from lower lip moved to code
780)
^ * RE RE
535 Cortical bone of mandible
Mandible, NOS
Cortical bone of maxilla (from commissure only)
Maxilla, NOS (from commissure only)
Cortical bone, NOS (not specified in higher codes)
Bone, NOS (not specified in higher codes)
^ * RE RE
700 OBSOLETE DATA RETAINED V0200
Mandible
ERROR T4a RE RE
725 Trabecular bone of mandible
Trabecular bone of maxilla (from commissure only
T4a T4a RE RE
740 Nose T4a T4a RE D
750 Tongue T4a T4a D D
760 Skin of face/neck T4a T4a D D
770 OBSOLETE DATA RETAINED V0200
Cortical bone (other than code 700)
Floor of mouth
Inferior alveolar nerve
ERROR T4a D D
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 51 Version 02.02.00
Code Description TNM 7 TNM 6 SS77 SS2000
775 Floor of mouth
Inferior alveolar nerve
T4a T4a D D
778 Stated as T4a with no other information on extension T4a T4a RE RE
780 Upper gingiva (from lower lip) T4b T4b D RE
785 780 + (740, 750, 760, or 775)
(Upper gingiva + Any structure in 740, 750, 760, or
775)
T4b T4b D D
788 Bone of maxilla (from lower lip)
Maxilla, NOS (from lower lip)
Specified bone (other than mandible, maxilla, and bones
in codes 790 and 800)
T4b T4b D D
790 Masticator space
Pterygoid plates
T4b T4b D D
800 Further contiguous extension including:
Skull base
Internal carotid artery (encased)
T4b T4b D D
810 Stated as T4b with no other information on extension T4b T4b D D
815 Stated as T4 [NOS] with no other information on
extension
T4NOS T4NOS RE RE
950 No evidence of primary tumor T0 T0 U U
999 Unknown extension
Primary tumor cannot be assessed
Not documented in patient record
TX TX U U
^ For Extension codes 100 through 535 ONLY, the T category for AJCC 7th Edition staging is assigned based on
the value of CS Tumor Size, as shown in the Extension Size Table for this site.
* For Extension codes 100 through 535 ONLY, the T category for AJCC 6th Edition staging is assigned based on
the value of CS Tumor Size, as shown in the Extension Size Table for this site.
Lip, Lower
CS Tumor Size/Ext Eval (Revised: 08/10/2009)
Code Description Staging
Basis
0 Does not meet criteria for AJCC pathologic staging:
No surgical resection done. Evaluation based on physical examination, imaging
examination, or other non-invasive clinical evidence. No autopsy evidence used.
c
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 52 Version 02.02.00
Code Description Staging
Basis
1 Does not meet criteria for AJCC pathologic staging:
No surgical resection done. Evaluation based on endoscopic examination, diagnostic
biopsy, including fine needle aspiration biopsy, or other invasive techniques, including
surgical observation without biopsy. No autopsy evidence used.
c
2 Meets criteria for AJCC pathologic staging:
No surgical resection done, but evidence derived from autopsy (tumor was suspected or
diagnosed prior to autopsy)
p
3 Either criteria meets AJCC pathologic staging:
Surgical resection performed WITHOUT pre-surgical systemic treatment or radiation
OR surgical resection performed, unknown if pre-surgical systemic treatment or radiation
performed
AND Evaluation based on evidence acquired before treatment, supplemented or modified
by the additional evidence acquired during and from surgery, particularly from
pathologic examination of the resected specimen.
No surgical resection done. Evaluation based on positive biopsy of highest T classification.
p
5 Does not meet criteria for AJCC y-pathologic (yp) staging:
Surgical resection performed AFTER neoadjuvant therapy and tumor size/extension based
on clinical evidence, unless the pathologic evidence at surgery (AFTER neoadjuvant)
is more extensive (see code 6).
c
6 Meets criteria for AJCC y-pathologic (yp) staging:
Surgical resection performed AFTER neoadjuvant therapy AND tumor size/extension
based on pathologic evidence, because pathologic evidence at surgery is more
extensive than clinical evidence before treatment.
yp
8 Meets criteria for autopsy (a) staging:
Evidence from autopsy only (tumor was unsuspected or undiagnosed prior to autopsy)
a
9 Unknown if surgical resection done
Not assessed; cannot be assessed
Unknown if assessed
Not documented in patient record
c
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 53 Version 02.02.00
Lip, Lower
CS Lymph Nodes (Revised: 07/27/2009) Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by
AJCC. The complete definitions are provided in the General Instructions.
Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes,
extracapsular extension, levels involved, and location of involved nodes above or below the lower border of the
cricoid cartilage)is coded in Site-Specific Factors 1, 3-9.
Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered
ipsilateral.
Note 4: For head and neck cancers, if lymph nodes are described only as "supraclavicular", try to determine if they
are in Level IV (deep to the sternocleidomastoid muscle, in the lower jugular chain) or Level V (in the posterior
triangle, inferior to the transverse cervical artery) and code appropriately. If the specific level cannot be determined,
consider them as Level V nodes.
Note 5: The description of lymph nodes has been standardized across the head and neck schemas. All lymph node
levels and groups listed here are considered regional nodes for AJCC staging. Summary Stage 1977 and Summary
Stage 2000 divide these nodes into regional and distant groups.
Code Description TNM 7 TNM 6 SS77 SS2000
000 None; no regional lymph node involvement N0 N0 NONE NONE
100 Single positive ipsilateral regional node:
Level I node:
Level IA - Submental Level IB
Submandibular (submaxillary), sublingual
Other groups Mandibular
Parotid
Infraauricular
Intraparotid
Periparotid
Preauricular
Regional lymph node, NOS
^ * RN RN
110 Single positive ipsilateral regional node:
Level II node - Upper jugular Jugulodigastric
(subdigastric)
Upper deep cervical
Level III node - Middle jugular Middle deep
cervical
Level IV node - Lower jugular Jugulo-
omohyoid (supraomohyoid)
Lower deep cervical
Virchow node
Cervical, NOS
Deep cervical, NOS
Internal jugular, NOS
^ * D RN
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 54 Version 02.02.00
Code Description TNM 7 TNM 6 SS77 SS2000
120 Single positive ipsilateral regional node:
Level V node - Posterior triangle group
Posterior cervical
Level VA - Spinal accessory
Level VB - Transverse cervical,
supraclavicular (see note 4) Level VI
node - Anterior compartment group
Laterotracheal
Paralaryngeal
Paratracheal - above suprasternal notch
Perithyroidal
Precricoid (Delphian)
Prelaryngeal
Pretracheal - above suprasternal notch
Recurrent laryngeal
Level VII node - Superior mediastinal group (for
other mediastinal nodes see CS Mets at DX)
Esophageal groove
Paratracheal - below suprasternal notch
Pretracheal - below suprasternal notch
Other groups
Facial
Buccinator (buccal)
Nasolabial
Parapharyngeal
Retroauricular
Retropharyngeal Suboccipital
^ * D D
180 Stated as N1, no other information N1 N1 RN RN
190 Stated as N2a, no other information N2a N2a RN RN
200 Multiple positive ipsilateral nodes listed in code 100 ^ * RN RN
210 Multiple positive ipsilateral nodes, any listed in code
110 (WITH or WITHOUT any nodes listed in code
100)
^ * D RN
220 Multiple positive ipsilateral nodes, any listed in code
120 (WITH or WITHOUT any nodes listed in code
100, 110)
^ * D D
290 Stated as N2b, no other information N2b N2b RN RN
300 Regional lymph nodes listed in code 100:
Positive ipsilateral node(s), not stated if single or
multiple
^ * RN RN
310 Regional lymph nodes listed in code 110:
Positive ipsilateral node(s), not stated if single or
multiple
^ * D RN
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29 April 2010 Part II - Lip - 55 Version 02.02.00
Code Description TNM 7 TNM 6 SS77 SS2000
320 Regional lymph nodes listed in code 120:
Positive ipsilateral node(s), not stated if single or
multiple
^ * D D
400 Regional lymph nodes listed in code 100:
Positive bilateral or contralateral nodes
^ * RN RN
410 Regional lymph nodes, any listed in code 110:
Positive bilateral or contralateral nodes (WITH or
WITHOUT any nodes listed in code 100)
^ * D RN
420 Regional lymph nodes, any listed in code 120:
Positive bilateral or contralateral node (WITH or
WITHOUT any nodes listed in code 100, 110)
^ * D D
490 Stated as N2c, no other information N2c N2c RN RN
500 Regional lymph nodes listed in code 100:
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral,
AND not stated if single or multiple
^ * RN RN
510 Regional lymph nodes listed in code 110:
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral,
AND not stated if single or multiple
^ * D RN
520 Regional lymph nodes listed in code 120:
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral,
AND not stated if single or multiple
^ * D D
600 Stated as N2, NOS N2NOS N2NOS RN RN
700 Stated as N3, no other information N3 N3 RN RN
800 Lymph nodes, NOS, no other information ^ * RN RN
999 Unknown; not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
NX NX U U
^ For codes 100-120, 200-220, 300-320, 400-420, 500-520, and 800 ONLY, the N category for AJCC 7th Edition
staging is assigned based on the value of Site Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph
Nodes Size Table, for this site.
* For codes 100-120, 200-220, 300-320, 400-420, 500-520, and 800 ONLY, the N category for AJCC 6th Edition
staging is assigned based on the value of Site Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph
Nodes Size Table, for this site.
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 56 Version 02.02.00
Lip, Lower
CS Lymph Nodes Eval (Revised: 10/26/2009) Note 1: This field is used primarily to derive the staging basis for the N category in the TNM system. It records
how the code for the item "CS Lymph Nodes" was determined based on the diagnostic methods employed and their
intent.
Note 2: In the 7th edition of the AJCC manual, the clinical and pathologic classification rules for the N category were
changed to reflect current medical practice. The N is designated as clinical or pathologic based on the intent
(workup versus treatment) matching with the assessment of the T classification. When the intent is workup, the
staging basis is clinical, and when the intent is treatment, the staging basis is pathologic.
A. Microscopic assessment including biopsy of regional nodes or sentinel nodes if being performed as part of
the workup to choose the treatment plan, is therefore part of the clinical staging. When it is part of the workup, the
T category is clinical, and there has not been a resection of the primary site adequate for pathologic T classification
(which would be part of the treatment).
B. Microscopic assessment of regional nodes if being performed as part of the treatment is therefore part of the
pathologic staging. When it is part of the treatment, the T category is pathologic, and there has been a resection of
the primary site adequate for pathologic T classification (all part of the treatment).
Note 3: Microscopic assessment of the highest N category is always pathologic (code 3).
Note 4: If lymph node dissection is not performed after neoadjuvant therapy, use code 0 or 1.
Note 5: Only codes 5 and 6 are used if the node assessment is performed after neoadjuvant therapy.
Code Description Staging
Basis
0 Does not meet criteria for AJCC pathologic staging:
No regional lymph nodes removed for examination. Evidence based on physical
examination, imaging examination, or other non-invasive clinical evidence. No
autopsy evidence used.
c
1 Does not meet criteria for AJCC pathologic staging based on at least one of the following
criteria:
No regional lymph nodes removed for examination. Evidence based on endoscopic
examination, or other invasive techniques including surgical observation, without
biopsy. No autopsy evidence used.
OR
Fine needle aspiration, incisional core needle biopsy, or excisional biopsy of regional
lymph nodes or sentinel nodes as part of the diagnostic workup, WITHOUT removal
of the primary site adequate for pathologic T classification (treatment).
c
2 Meets criteria for AJCC pathologic staging:
No regional lymph nodes removed for examination, but evidence derived from autopsy
(tumor was suspected or diagnosed prior to autopsy).
p
3 Meets criteria for AJCC pathologic staging based on at least one of the following criteria:
Any microscopic assessment of regional nodes (including FNA, incisional core needle bx,
excisional bx, sentinel node bx or node resection), WITH removal of the primary site
adequate for pathologic T classification (treatment) or biopsy assessment of the highest
T category.
OR
Any microscopic assessment of a regional node in the highest N category, regardless of the
T category information.
p
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29 April 2010 Part II - Lip - 57 Version 02.02.00
Code Description Staging
Basis
5 Does not meet criteria for AJCC y-pathologic (yp) staging:
Regional lymph nodes removed for examination AFTER neoadjuvant therapy AND lymph
node evaluation based on clinical evidence, unless the pathologic evidence at surgery
(AFTER neoadjuvant) is more extensive (see code 6).
c
6 Meets criteria for AJCC y-pathologic (yp) staging:
Regional lymph nodes removed for examination AFTER neoadjuvant therapy AND lymph
node evaluation based on pathologic evidence, because the pathologic evidence at
surgery is more extensive than clinical evidence before treatment.
yp
8 Meets criteria for AJCC autopsy (a) staging:
Evidence from autopsy; tumor was unsuspected or undiagnosed prior to autopsy.
a
9 Unknown if lymph nodes removed for examination
Not assessed; cannot be assessed
Unknown if assessed
Not documented in patient record
c
Lip, Lower
Reg LN Pos (Revised: 03/30/2009) Note: Record this field even if there has been preoperative treatment.
Code Description
00 All nodes examined negative.
01-89 1 - 89 nodes positive (code exact number of nodes positive)
90 90 or more nodes positive
95 Positive aspiration or core biopsy of lymph node(s)
97 Positive nodes - number unspecified
98 No nodes examined
99 Unknown if nodes are positive; not applicable
Not documented in patient record
Lip, Lower
Reg LN Exam (Revised: 03/02/2009)
Code Description
00 No nodes examined
01-89 1 - 89 nodes examined (code exact number of regional lymph nodes examined)
90 90 or more nodes examined
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Code Description
95 No regional nodes removed, but aspiration or core biopsy of regional nodes performed
96 Regional lymph node removal documented as sampling and number of nodes unknown/not stated
97 Regional lymph node removal documented as dissection and number of nodes unknown/not stated
98 Regional lymph nodes surgically removed but number of lymph nodes unknown/not stated and not
documented as sampling or dissection; nodes examined, but number unknown
99 Unknown if nodes were examined; not applicable or negative
Not documented in patient record
Lip, Lower
CS Mets at DX (Revised: 07/23/2009) Note: Supraclavicular and transverse cervical lymph nodes are coded in CS Lymph Nodes because they are
categorized as N rather than M in AJCC TNM.
Code Description TNM 7 TNM 6 SS77 SS2000
00 No; none M0 M0 NONE NONE
10 Distant lymph node(s)
Mediastinal
Distant lymph node(s), NOS
M1 M1 D D
40 Distant metastases except distant lymph node(s)(code
10)
Carcinomatosis
M1 M1 D D
50 (10) + (40)
Distant lymph node(s) plus other distant metastases
M1 M1 D D
60 Distant metastasis, NOS
Stated as M1, NOS
M1 M1 D D
99 Unknown if distant metastasis
Distant metastasis cannot be assessed
Not documented in patient record
M0 MX U U
Lip, Lower
CS Mets Eval (Revised: 08/10/2009) Note: This item reflects the validity of the classification of the item CS Mets at DX only according to the
diagnostic methods employed.
Code Description Staging
Basis
0 Does not meet criteria for AJCC pathologic staging of distant metastasis:
Evaluation of distant metastasis based on physical examination, imaging examination,
and/or other non-invasive clinical evidence. No pathologic examination of metastatic
tissue performed or pathologic examination was negative.
c
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Code Description Staging
Basis
1 Does not meet criteria for AJCC pathologic staging of distant metastasis:
Evaluation of distant metastasis based on endoscopic examination or other invasive
technique, including surgical observation without biopsy. No pathologic examination
of metastatic tissue performed or pathologic examination was negative.
c
2 Meets criteria for AJCC pathologic staging of distant metastasis:
No pathologic examination of metastatic specimen done prior to death, but positive
metastatic evidence derived from autopsy (tumor was suspected or diagnosed prior to
autopsy).
p
3 Meets criteria for AJCC pathologic staging of distant metastasis:
Specimen from metastatic site microscopically positive WITHOUT pre-surgical systemic
treatment or radiation
OR specimen from metastatic site microscopically positive, unknown if pre-surgical
systemic treatment or radiation performed
OR specimen from metastatic site microscopically positive prior to neoadjuvant treatment.
p
5 Does not meet criteria for AJCC y-pathologic (yp) staging of distant metastasis:
Specimen from metastatic site microscopically positive WITH pre-surgical systemic
treatment or radiation, BUT metastasis based on clinical evidence.
c
6 Meets criteria for AJCC y-pathologic (yp) staging of distant metastasis:
Specimen from metastatic site microscopically positive WITH pre-surgical systemic
treatment or radiation, BUT metastasis based on pathologic evidence.
yp
8 Meets criteria for AJCC autopsy (a) staging of distant metastasis:
Evidence from autopsy based on examination of positive metastatic tissue AND tumor was
unsuspected or undiagnosed prior to autopsy.
a
9 Not assessed; cannot be assessed
Unknown if assessed
Not documented in patient record
c
Lip, Lower
CS Site-Specific Factor 1 Size of Lymph Nodes (Revised: 12/01/2009) Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph
node(s). Do not code the size of any nodes coded in CS Mets at DX.
Code Description
000 No involved regional nodes
001-979 001-979 millimeters (code exact size in millimeters)
980 980 millimeters or larger
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Code Description
981-988 OBSOLETE DATA CONVERTED V0200
See code 980
981-988 millimeters
989 OBSOLETE DATA CONVERTED V0200
See code 980
989 millimeters or larger
990 Microscopic focus or foci only, no size of focus given
991 Described as "less than 1cm"
992 Described as "less than 2cm" or "greater than 1cm" or "between 1cm and 2cm"
993 Described as "less than 3cm" or "greater than 2cm" or "between 2cm and 3cm"
994 Described as "less than 4cm" or "greater than 3cm" or "between 3cm and 4cm"
995 Described as "less than 5cm" or "greater than 4cm" or "between 4cm and 5cm"
996 Described as "less than 6cm" or "greater than 5cm" or "between 5cm and 6cm"
997 Described as "more than 6cm"
999 Regional lymph node(s) involved, size not stated
Unknown if regional lymph node(s) involved
Not documented in patient record
Lip, Lower
CS Site-Specific Factor 2 OBSOLETE - Extracapsular Extension, Lymph Nodes for Head
and Neck (Revised: 12/30/2009) Note 1: This CS Site-Specific Factor is obsolete beginning with CS Version 2 (codes and notes). Old data are
retained, but new cases are not coded with this Factor. Use code 988 for this field.
Note 2: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved
regional lymph node(s) coded in the CS Lymph Nodes field. Do not code extracapsular extension in any nodes
coded in CS Mets at DX in this field.
Note 3: A statement of the presence or absence of extracasular extension in a pathology report takes priority over
clinical assessment. However, if the pathology report contains no statement about extracapsular extension, either
positive or negative, the clinical assessment should be coded. If nodes are involved but there is neither a clinical
assessment of extranodal extension nor a statement about it in the pathology report, use code 999.
Note 4: According to AJCC (page 24), "Imaging studies showing amorphous speculated margins of involved nodes
or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular
(extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such
disease."
Note 5: CS Site-Specific Factor 2 is obsolete beginning with CS Version 2 (codes and notes). Old data are retained,
but new cases are not coded with this Factor. Use code 988 for this field.
Code Description
000 OBSOLETE DATA RETAINED V0200
No extracapsular extension
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Code Description
001 OBSOLETE DATA RETAINED V0200
Extracapsular extension clinically, not assessed pathologically
Nodes described as "fixed", not assessed pathologically
005 OBSOLETE DATA RETAINED V0200
Extracapsular extension present pathologically
888 OBSOLETE DATA CONVERTED V0200
See code 987
Not applicable; no lymph node involvement
987 OBSOLETE DATA CONVERTED AND RETAINED V0200
Data converted from code 888
Not applicable; no lymph node involvement
988 Not applicable:
Information not collected for this case
999 OBSOLETE DATA RETAINED V0200
Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Lip, Lower
CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck (Revised: 03/30/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Code Description
000 No lymph node involvement in Levels I, II, or III
100 Level I lymph node(s) involved
010 Level II lymph node(s) involved
001 Level III lymph node(s) involved
110 Level I and II lymph nodes involved
101 Level I and III lymph nodes involved
011 Level II and III lymph nodes involved
111 Level I, II and III lymph nodes involved
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Code Description
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Lip, Lower
CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and
Neck (Revised: 03/30/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Code Description
000 No lymph node involvement in Levels IV or V or retropharyngeal
100 Level IV lymph node(s) involved
010 Level V lymph node(s) involved
001 Retropharyngeal nodes involved
110 Level IV and V lymph nodes involved
101 Level IV and retropharyngeal nodes involved
011 Level V and retropharyngeal nodes involved
111 Level IV and V and retropharyngeal lymph nodes involved
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Lip, Lower
CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck (Revised:
03/30/2009) Note 1: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Note 2: Facial nodes including buccinator, mandibular, and nasolabial lymph nodes.
Code Description
000 No lymph node involvement in Levels VI or VII or facial nodes
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Code Description
100 Level VI lymph node(s) involved
010 Level VII lymph node(s) involved
001 Facial lymph node(s) involved
110 Level VI and VII lymph nodes involved
101 Level VI and facial nodes involved
011 Level VII and facial nodes involved
111 Level VI and VII and facial lymph nodes involved
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Lip, Lower
CS Site-Specific Factor 6 Parapharyngeal, Parotid, and Suboccipital/Retroauricular
Lymph Nodes, Lymph Nodes for Head and Neck (Revised: 08/25/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Code Description
000 No involvement of any group:
Parapharyngeal lymph nodes
Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes
Suboccipital/retroauricular lymph nodes
100 Parapharyngeal lymph node(s) involved
010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved
001 Suboccipital/retroauricular lymph node(s) involved
110 Involvement of two groups:
Parapharyngeal lymph nodes
Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes
101 Involvement of two groups:
Parapharyngeal lymph nodes
Suboccipital/retroauricular lymph nodes
011 Involvement of two groups:
Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes
Suboccipital lymph nodes
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Code Description
111 Involvement of three groups:
Parapharyngeal lymph nodes
Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes
, Suboccipital/retroauricular lymph nodes
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Lip, Lower
CS Site-Specific Factor 7 Upper and Lower Cervical Node Levels (Revised: 03/30/2009) Note 1: AJCC requires that nodes be designated as involving upper or lower levels within the neck. The boundary
between upper and lower levels is the lower border of the cricoid cartilage.
Note 2: Nodes in Levels I, II, and III are upper level nodes. Nodes in Level IV and VII are lower level nodes.
Level VA nodes are upper level nodes, and Level VB are lower level nodes. Level VI nodes span both upper and
lower levels. Nodes included in "Other groups" (Facial, Parotid, Parapharyngeal, Retropharyngeal, Retroauricular,
and Suboccipital) are all upper level nodes.
Note 3: Code the location of nodal involvement in relation to the lower border of the cricoid cartilage of all
involved nodes, whether assessed clinically or pathologically, as stated by a physician.
Note 4: If there is no physician statement of upper and/or lower level nodal involvement, assign levels I, II, III, and
VA nodes to upper level. Assign level IV, VB, and VII to lower level. If Level V (A and B not specified) and/or
Level VI nodes are involved with no further information about location, use code 040.
Note 5: A description of "mid neck" requires clarification with the physician. Code 040, unknown level, if "mid
neck" is the only information available.
Code Description
000 No lymph nodes involved
010 Upper level lymph nodes involved (all involved nodes above the lower border of the cricoid cartilage)
020 Lower level lymph nodes involved (all involved nodes below the lower border of the cricoid cartilage)
030 Upper and lower level lymph nodes involved (all involved nodes both above and below the lower
border of the cricoid cartilage)
040 Unknown level lymph nodes involved (unable to determine if involved nodes above or below the lower
border of the cricoid cartilage)
988 Not applicable:
Information not collected for this case
999 Unknown if regional lymph node(s) involved, not stated Not documented in patient record
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Lip, Lower
CS Site-Specific Factor 8 Extracapsular Extension Clinically, Lymph Nodes for Head and
Neck (Revised: 10/16/2009) Note 1: Code the status of extracapsular extension accessed clinically for any involved regional lymph node(s)
coded in the CS Lymph Nodes field. Do not code extracapsular extensio in any nodes coded in CS Mets at DX in
this field.
Note 2: If nodes are involved clinically, and documentation of physical examination or imaging is available
without a statement of extracapsular extension, use code 010.
Note 3: If the only documentation is a reference to clinically involved nodes with no reference to extracapsular
extension, use code 030.
Note 4: If there is no information about clinical assessment of nodes, use code 999.
Note 5: Clinical assessment can be by physical examination or imaging. According to AJCC, "ECS can be
diagnosed clinically by a matted mass of nodes adherent to overlying skin, adjacent soft tissue, or clinical evidence
of cranial nerve tissue. Radiologic signs of ECS include amorphous, spiculated margins of a metastatic node and
stranding of the perinodal soft tissue in previously untreated patients."
Code Description
000 No lymph nodes involved clinically
010 Nodes involved clinically, no extracapsular extension clinically
020 Nodes involved clinically, extracapsular extension clinically (nodes described as fixed or matted)
030 Nodes involved clinically, unknown if extracapsular extension
988 Not applicable:
Information not collected for this case
997 Clinical examination of lymph nodes performed, unknown results
998 No clinical examination of lymph nodes
999 Unknown if regional lymph node(s) involved clinically, not stated Regional lymph nodes cannot be
accessed Not documented in patient record
Lip, Lower
CS Site-Specific Factor 9 Extracapsular Extension Pathologically, Lymph Nodes for Head
and Neck (Revised: 08/25/2009) Note 1: Code the status of extracapsular extension assessed pathologically of any involved regional lymph node(s)
coded in the CS Lymph Nodes field. Do not code extracapsular extension in any nodes coded in CS Mets at DX in
this field.
Note 2: If nodes are involved pathologically but there is no statement of extranodal extension in the pathology
report, use code 010.
Note 3: Code "microscopic" or "macroscropic" extranodal extension as stated in the final diagnosis. If not stated in
the final diagnosis, code "microscopic" if extranodal extension is described only in the microscopic section of the
pathology report and "macroscopic" if extranodal extension is described in the gross section of the pathology report.
Note 4: "Macroscopic" extension takes priority over "microscopic" extension.
Note 5: Use code 040 if pathologic extracapsular extension is described with no further information and the
pathology report is not available for review.
Note 6: Use code 050 if nodes involved pathologically with no further information about extracapsular extension.
Code Description
000 No lymph nodes involved pathologically
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Code Description
010 Nodes involved pathologically, no extracapsular extension pathologically
020 Nodes involved pathologically, MICROSCOPIC extracapsular extension pathologically
030 Nodes involved pathologically, MACROSCOPIC extracapsular extension pathologically
040 Nodes involved pathologically, extracapsular extension pathologically, unknown if microscopic or
macroscopic
050 Nodes involved pathologically, unknown if extracapsular extension
988 Not applicable:
Information not collected for this case
997 Pathologic examination of lymph nodes performed, results not available
998 No pathologic examination of lymph nodes
999 Unknown if regional lymph node(s) involved pathologically, not stated
Lip, Lower
CS Site-Specific Factor 10 HPV (Human Papilloma Virus) Status (Revised: 10/12/2009) Note 1: There is evidence that human papilloma virus (HPV) plays a role in the pathogenesis of some cancers.
Note 2: Record the results of any HPV testing performed on pathologic specimens from the primary tumor or a
metastatic site, including regional nodes. HPV testing may be performed for prognostic purposes; testing may also
be performed on metastatic sites to aid in the determination of the primary site.
Note 3: The highest risk HPV types are types 16 and 18. Other high risk types are 31, 33, 35, 36, 45, 51, 52, 56, 58,
59, 68, 26, 53, 66, 67, 69, 70, 73, 82, 85 Low risk types are 6, 11, 32, 34, 40, 42, 44, 54, 61, 62, 64, 71, 72, 74, 81,
83, 84, 87, 89. The HPV vaccine is designed to protect against types 16 and 18 (associated with cervical cancer) and
types 6 and 11 (associated with genital warts).
Note 4: High risk may be abbreviated "hrHPV" or "HR-HPV".
Note 5: Some tests for HPV, such as a hybrid capture test, only report negative or positive for high risk HPV
without identifying types; use codes 025 and 050, respectively to report those test results.
Code Description
000 HPV test negative; not positive for any HPV types
Negative, NOS
010 LOW RISK positive (all positive type(s) are low risk)
020 HIGH RISK positive, specified type(s) other than types 16 or 18,
WITH or WITHOUT positive results for low risk type(s)
030 HIGH RISK positive for HPV 16 WITHOUT positive results for HPV 18 or positivity of HPV 18
unknown,
WITH or WITHOUT positive results for other high-risk types,
WITH or WITHOUT positive results for low risk type(s)
040 HIGH RISK positive for HPV 18 WITHOUT positive results for HPV 16 or positivity of HPV 16
unknown,
WITH or WITHOUT positive results for other high-risk types,
WITH or WITHOUT positive results for low risk type(s)
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Code Description
050 HIGH RISK positive for HPV 16 AND HPV 18,
WITH or WITHOUT positive results for other high-risk types,
WITH or WITHOUT positive results for low risk type(s)
060 HIGH RISK positive, NOS, type(s) not specified
070 Positive, NOS, risk and type(s) not stated
988 Not applicable:
Information not collected for this case
997 Test ordered, results not in chart
998 Test not done (test was not ordered and was not performed), including no pathologic specimen
available for HPV testing
999 Unknown or no information
Not documented in patient record
Lip, Lower
CS Site-Specific Factor 11 Measured Thickness (Depth) (Revised: 11/15/2009) Note 1: Code MEASURED THICKNESS (Depth) of the invasive tumor not size, diameter, or any other
measurement. Record the actual measurement in tenths of millimeters as stated on the pathology repot. Do not
record the measurement from a radiographic report.
Note 2: Record the measurement labeled specifically as thickness or depth of tumor. In the absence of a label,use
the "cut surface" dimension, or the third dimension from a description of 3 dimensions (N1 x N2 x N3). For
example, from a tumor size recorded as 2cm x 1cm x 0.5cm, record 050.
Code Description
000 No mass/tumor found
001-979 Exact thickness in tenths of millimeters
Examples:
001 0.1 millimeter
010 1 millimeter
042 4.2 millimeters
100 10 millimeters, 1 centimeter
103 10.3 millimeters
980 98.0 millimeters or larger
987 Not applicable, in situ carcinoma
988 Not applicable:
Information not collected for this case
990 Microinvasion
Microscopic focus or foci only; no depth given
998 No surgical specimen
999 Not documented in patient record
Unknown, thickness not stated
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Lip, Lower
CS Site-Specific Factor 12 (Revised: 06/30/2008)
Code Description
988 Not applicable for this schema
Lip, Lower
CS Site-Specific Factor 13 (Revised: 06/30/2008)
Code Description
988 Not applicable for this schema
Lip, Lower
CS Site-Specific Factor 14 (Revised: 06/30/2008)
Code Description
988 Not applicable for this schema
Lip, Lower
CS Site-Specific Factor 15 (Revised: 06/30/2008)
Code Description
988 Not applicable for this schema
Lip, Lower
CS Site-Specific Factor 16 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Lip, Lower
CS Site-Specific Factor 17 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Lip, Lower
CS Site-Specific Factor 18 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
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Lip, Lower
CS Site-Specific Factor 19 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Lip, Lower
CS Site-Specific Factor 20 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Lip, Lower
CS Site-Specific Factor 21 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Lip, Lower
CS Site-Specific Factor 22 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Lip, Lower
CS Site-Specific Factor 23 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Lip, Lower
CS Site-Specific Factor 24 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Lip, Lower
CS Site-Specific Factor 25 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
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Malignant Melanoma of Lower Lip
Lip (Vermilion or Labial Mucosa)
C00.1, C00.4, C00.6 (M-8720-8790)
C00.0 External upper lip
C00.3 Mucosa of upper lip
C00.6 Commissure of lip
Note: AJCC includes labial mucosa (C00.3) with buccal mucosa (C06.0)
CS Tumor Size CS Extension CS Tumor Size/Ext Eval CS Lymph Nodes CS Lymph Nodes Eval Reg LN Pos Reg LN Exam CS Mets at DX CS Mets Eval
CS Site-Specific Factor 1 Size of Lymph Nodes CS Site-Specific Factor 2 OBSOLETE -
Extracapsular Extension, Lymph Nodes for
Head and Neck CS Site-Specific Factor 3 Levels I-III, Lymph
Nodes for Head and Neck CS Site-Specific Factor 4 Levels IV-V and
Retropharyngeal Lymph Nodes for Head and
Neck CS Site-Specific Factor 5 Levels VI-VII and
Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 Parapharyngeal,
Parotid, and Suboccipital/Retroauricular Lymph
Nodes, Lymph Nodes for Head and Neck CS Site-Specific Factor 7 Upper and Lower
Cervical Node Levels CS Site-Specific Factor 8 Extracapsular
Extension Clinically, Lymph Nodes for Head
and Neck CS Site-Specific Factor 9 Extracapsular
Extension Pathologically, Lymph Nodes for
Head and Neck CS Site-Specific Factor 10 HPV (Human
Papilloma Virus) Status CS Site-Specific Factor 11 Measured Thickness
(Depth) CS Site-Specific Factor 12 CS Site-Specific Factor 13 CS Site-Specific Factor 14 CS Site-Specific Factor 15 CS Site-Specific Factor 16 CS Site-Specific Factor 17 CS Site-Specific Factor 18 CS Site-Specific Factor 19 CS Site-Specific Factor 20 CS Site-Specific Factor 21 CS Site-Specific Factor 22 CS Site-Specific Factor 23 CS Site-Specific Factor 24 CS Site-Specific Factor 25
The following tables are
available at the collaborative
staging website:
Histology Inclusion Table
AJCC 7th ed. Histology Exclusion Table
AJCC 6th ed. AJCC TNM 7 Stage AJCC TNM 6 Stage Summary Stage
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Malignant Melanoma of Lower Lip
CS Tumor Size (Revised: 02/03/2010)
Code Description
000 No mass/tumor found
001-988 001 - 988 millimeters (code exact size in millimeters)
989 989 millimeters or larger
990 Microscopic focus or foci only and no size of focus given
991 Described as "less than 1 cm"
992 Described as "less than 2 cm," or "greater than 1 cm," or "between 1 cm and 2 cm"
993 Described as "less than 3 cm," or "greater than 2 cm," or "between 2 cm and 3 cm"
994 Described as "less than 4 cm," or "greater than 3 cm," or "between 3 cm and 4 cm"
995 Described as "less than 5 cm," or "greater than 4 cm," or "between 4 cm and 5 cm"
999 Unknown; size not stated
Not documented in patient record
Malignant Melanoma of Lower Lip
CS Extension (Revised: 01/04/2010) Note 1: AJCC does not include a Tis or TX category for melanoma of mucosa of head and neck sites. Extension codes of
000 and 999 will be mapped to NA and AJCC stage group will be derived as NA.
Note 2: AJCC does not include a T1 or T2 category for mucosal melanoma of head and neck sites.
Note 3: Use code 300 for localized tumor ONLY if no information is available to assign code 105 or 470.
Note 4: Use code 470, 775, 810, or 815 if the physician's assignment of T category is the ONLY information
available about the extent of the tumor.
Code Description TNM 7 TNM 6 SS77 SS2000
000 In situ; noninvasive; intraepithelial NA NA IS IS
100 OBSOLETE DATA RETAINED V0200
Invasive tumor confined to:
Labial mucosa (inner lip)
Lamina propria
Multiple foci
Submucosa (superficial invasion)
Vermilion surface
Superficial extension to:
Skin of lip
Subcutaneous soft tissue of lip
ERROR NA L L
105 Tumor confined to mucosa of lower lip:
Labial mucosa (inner lip)
Vermilion surface
T3 NA L L
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Code Description TNM 7 TNM 6 SS77 SS2000
200 OBSOLETE DATA CONVERTED V0200
See code 520
Musculature
ERROR ERROR ERROR ERROR
300 Localized, NOS T3 NA L L
400 Extension via mucosa to:
Inner cheek (buccal mucosa)
Commissure (for lower lip)
Opposite (both) lip(s)
T3 NA RE RE
410 Extension via mucosa to:
Lower gingiva
Gingiva NOS
T3 NA RE RE
440 Extension via mucosa to upper gingiva T3 NA D RE
450 Extension via mucosa to:
Floor of mouth
Tongue
T3 NA D D
470 Stated as T3 with no other information on extension T3 NA L L
500 OBSOLETE DATA RETAINED V0200
Buccal mucosa (inner cheek)
Commissure
ERROR NA RE RE
510 OBSOLETE DATA RETAINED V0200
Gingiva
ERROR NA RE RE
520 Involvement of deep soft tissue or musculature of lower
lip
Soft tissue NOS
T4a NA L L
530 520 + (400 or 410)
(Involvement of deep soft tissue or musculature of
lower lip + Mucosal involvement of any structure
in code 400 or 410)
T4a NA RE RE
540 Involvement of deep soft tissue or musculature of any
structure in code 400
T4a NA RE RE
550 Involvement of deep tissue or periosteum of lower
gingiva
T4a NA RE RE
700 Cartilage of mandible
Cartilage NOS
Cortical bone of mandible
Cortical bone NOS
Mandible, NOS
Bone NOS except maxilla, skull base
T4a NA RE RE
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Code Description TNM 7 TNM 6 SS77 SS2000
705 520, 540, or 700) + 440
(Any structure in code 520 or 540 + Mucosa of upper
gingiva)
T4a NA D RE
710 Deep tissue or periosteum of upper gingiva T4a NA D RE
740 Skin of nose T4a NA RE D
743 740 + (440 or 710)
(Skin of nose + Mucosa or deep tissue upper gingiva)
T4a NA D D
745 (520, 540, 700, 710, or 740) + 450
(Any structure in code 520, 540, 700, 710, or 740 +
Mucosa of floor of mouth or tongue)
T4a NA D D
748 Involvement of deep tissue or musculature of floor of
mouth or tongue
Inferior alveolar nerve
T4a NA D D
750 OBSOLETE DATA RETAINED V0200
Tongue
ERROR NA D D
755 Extrinsic muscle of tongue
Genioglossus
Hyoglossus
Palatoglossus
Styloglossus
T4a NA D D
760 Skin of face/neck T4a NA D D
765 Cartilage of maxilla
Cortical bone of maxilla
Maxilla NOS
T4a NA D D
770 OBSOLETE DATA RETAINED V0200
Cortical bone (other than code 700)
Floor of mouth
Inferior alveolar nerve
ERROR NA D D
775 Stated as T4a with no other information on extension T4a NA L L
790 Contiguous extension:
Masticator space
Pterygoid plates
Skull base
Internal carotid artery (encased)
T4b NA D D
800 OBSOLETE DATA RETAINED V0200
Further contiguous extension
ERROR NA D D
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Code Description TNM 7 TNM 6 SS77 SS2000
801 Further contiguous extension including:
Brain
Dura
Lower cranial nerves (IX, X, XI, XII)
Prevertebral space
Mediastinal structures
T4b NA D D
810 Stated as T4b with no other information on extension T4b NA D D
815 Stated as T4 NOS with no other information on
extension
T4NOS NA L L
950 OBSOLETE DATA RETAINED V0200
No evidence of primary tumor
ERROR NA U U
999 Unknown extension
Primary tumor cannot be assessed
Not documented in patient record
NA NA U U
Malignant Melanoma of Lower Lip
CS Tumor Size/Ext Eval (Revised: 11/13/2009)
Code Description Staging
Basis 7
Staging
Basis 6
0 Does not meet criteria for AJCC pathologic staging:
No surgical resection done. Evaluation based on physical examination,
imaging examination, or other non-invasive clinical evidence. No autopsy
evidence used.
c
1 Does not meet criteria for AJCC pathologic staging:
No surgical resection done. Evaluation based on endoscopic examination,
diagnostic biopsy, including fine needle aspiration biopsy, or other
invasive techniques, including surgical observation without biopsy. No
autopsy evidence used.
c
2 Meets criteria for AJCC pathologic staging:
No surgical resection done, but evidence derived from autopsy (tumor was
suspected or diagnosed prior to autopsy)
p
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Code Description Staging
Basis 7
Staging
Basis 6
3 Either criteria meets AJCC pathologic staging:
Surgical resection performed WITHOUT pre-surgical systemic treatment or
radiation
OR surgical resection performed, unknown if pre-surgical systemic treatment or
radiation performed
AND Evaluation based on evidence acquired before treatment, supplemented or
modified by the additional evidence acquired during and from surgery,
particularly from pathologic examination of the resected specimen.
No surgical resection done. Evaluation based on positive biopsy of highest T
classification.
p
5 Does not meet criteria for AJCC y-pathologic (yp) staging:
Surgical resection performed AFTER neoadjuvant therapy and tumor
size/extension based on clinical evidence, unless the pathologic evidence at
surgery (AFTER neoadjuvant) is more extensive (see code 6).
c
6 Meets criteria for AJCC y-pathologic (yp) staging:
Surgical resection performed AFTER neoadjuvant therapy AND tumor
size/extension based on pathologic evidence, because pathologic evidence
at surgery is more extensive than clinical evidence before treatment.
yp
8 Meets criteria for autopsy (a) staging:
Evidence from autopsy only (tumor was unsuspected or undiagnosed prior to
autopsy)
a
9 Unknown if surgical resection done
Not assessed; cannot be assessed
Unknown if assessed
Not documented in patient record
c
Malignant Melanoma of Lower Lip
CS Lymph Nodes (Revised: 12/26/2009) Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by
AJCC. The complete definitions are provided in the General Instructions.
Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes,
extracapsular extension, levels involved, and location above or below the lower border of the criocid cartilage) is
coded in Site-Specific Factors 1, 3-9.
Note 3: For head and neck cancers, if lymph nodes are described only as "supraclavicular", try to determine if they
are in Level IV (deep to the sternocleidomastoid muscle, in the lower jugular chain) or Level V (in the posterior
triangle, inferior to the transverse cervical artery) and code appropriately. If the specific level cannot be determined,
consider them as Level V nodes.
Code Description TNM 7 TNM 6 SS77 SS2000
000 None; no regional lymph node involvement N0 NA NONE NONE
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Code Description TNM 7 TNM 6 SS77 SS2000
100 Positive regional node(s):
Level I node:
Level IA - Submental(submaxillary),
sublingual
Level IB - Submandibular
Mandibular
Parotid:
Infraauricular
Intraparotid
Periparotid
Preauricular
Regional lymph node, NOS
N1 NA RN RN
110 Positive regional node(s):
Level II node - Upper jugular
Jugulodigastric (subdigastric)
Upper deep cervical
Level III node - Middle jugular
Middle deep cervical
Level IV node - Lower jugular
Jugulo-omohyoid (supraomohyoid)
Lower deep cervical
Virchow node
Cervical, NOS
Deep cervical, NOS
Internal jugular, NOS
N1 NA D RN
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Code Description TNM 7 TNM 6 SS77 SS2000
120 Positive regional node(s):
Level V node - Posterior triangle group
Posterior cervical
Level VA - Spinal accessory
Level VB - Transverse cervical,
supraclavicular (see Note 3)
Level VI node - Anterior compartment group
Laterotracheal
Paralaryngeal
Paratracheal - above suprasternal notch
Perithyroidal
Precricoid ( Delphian)
Prelaryngeal
Pretracheal - above suprasternal notch
Recurrent laryngeal
Level VII node - Superior mediastinal group
(for other mediastinal nodes see CS Mets at
DX)
Esophageal groove
Paratracheal - below suprasternal notch
Pretracheal - below suprasternal notch
Buccinator (buccal)
Nasolabial
Other groups:
Parapharyngeal
Retroauricular (mastoid)
Retropharyngeal
Suboccipital
N1 NA D D
180 Stated as N1, no other information N1 NA RN RN
190 OBSOLETE DATA RETAINED V0200
Stated as N2a, no other information
ERROR NA RN RN
200 OBSOLETE DATA RETAINED V0200
Multiple positive ipsilateral nodes listed in code 100
ERROR NA RN RN
210 OBSOLETE DATA RETAINED V0200
Multiple positive ipsilateral nodes listed in code 110
ERROR NA D RN
220 OBSOLETE DATA RETAINED V0200
Multiple positive ipsilateral nodes, any listed in code
120
ERROR NA D D
290 OBSOLETE DATA RETAINED V0200
Stated as N2b, no other information
ERROR NA RN RN
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Code Description TNM 7 TNM 6 SS77 SS2000
300 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 100:
Positive ipsilateral node(s), not stated if single or
multiple
ERROR NA RN RN
310 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 110
Positive ipsilateral node(s), not stated if single or
multiple
ERROR NA D RN
320 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 120:
Positive ipsilateral node(s), not stated if single or
multiple
ERROR NA D D
400 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 100:
Positive bilateral or contralateral nodes
ERROR NA RN RN
410 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 110
Positive bilateral or contralateral nodes
ERROR NA D RN
420 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 120:
Positive bilateral or contralateral nodes
ERROR NA D D
490 OBSOLETE DATA RETAINED V0200
Stated as N2c, no other information
ERROR NA RN RN
500 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 100:
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral,
AND not stated if single or multiple
ERROR NA RN RN
510 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 110
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral
AND not stated if single or multiple
ERROR NA D RN
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Code Description TNM 7 TNM 6 SS77 SS2000
520 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 120:
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral,
AND not stated if single or multiple
ERROR NA D D
600 OBSOLETE DATA RETAINED V0200
Stated as N2, NOS
ERROR NA RN RN
700 OBSOLETE DATA RETAINED V0200
Stated as N3, no other information
ERROR NA RN RN
800 Lymph nodes, NOS, no other information N1 NA RN RN
999 Unknown; not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
NX NA U U
Malignant Melanoma of Lower Lip
CS Lymph Nodes Eval (Revised: 11/13/2009) Note 1: This field is used primarily to derive the staging basis for the N category in the TNM system. It records
how the code for the item "CS Lymph Nodes" was determined based on the diagnostic methods employed and their
intent.
Note 2: In the 7th edition of the AJCC manual, the clinical and pathologic classification rules for the N category were
changed to reflect current medical practice. The N is designated as clinical or pathologic based on the intent
(workup versus treatment) matching with the assessment of the T classification. When the intent is workup, the
staging basis is clinical, and when the intent is treatment, the staging basis is pathologic.
A. Microscopic assessment including biopsy of regional nodes or sentinel nodes if being performed as part of
the workup to choose the treatment plan, is therefore part of the clinical staging. When it is part of the workup, the
T category is clinical, and there has not been a resection of the primary site adequate for pathologic T classification
(which would be part of the treatment).
B. Microscopic assessment of regional nodes if being performed as part of the treatment is therefore part of the
pathologic staging. When it is part of the treatment, the T category is pathologic, and there has been a resection of
the primary site adequate for pathologic T classification (all part of the treatment).
Note 3: Microscopic assessment of the highest N category is always pathologic (code 3).
Note 4: If lymph node dissection is not performed after neoadjuvant therapy, use code 0 or 1.
Note 5: Only codes 5 and 6 are used if the node assessment is performed after neoadjuvant therapy.
Code Description Staging
Basis 7
Staging
Basis 6
0 Does not meet criteria for AJCC pathologic staging:
No regional lymph nodes removed for examination. Evidence based on
physical examination, imaging examination, or other non-invasive clinical
evidence. No autopsy evidence used.
c
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Code Description Staging
Basis 7
Staging
Basis 6
1 Does not meet criteria for AJCC pathologic staging based on at least one of the
following criteria:
No regional lymph nodes removed for examination. Evidence based on
endoscopic examination, or other invasive techniques including surgical
observation, without biopsy. No autopsy evidence used.
OR
Fine needle aspiration, incisional core needle biopsy, or excisional biopsy of
regional lymph nodes or sentinel nodes as part of the diagnostic workup,
WITHOUT removal of the primary site adequate for pathologic T
classification (treatment).
c
2 Meets criteria for AJCC pathologic staging:
No regional lymph nodes removed for examination, but evidence derived from
autopsy (tumor was suspected or diagnosed prior to autopsy).
p
3 Meets criteria for AJCC pathologic staging based on at least one of the
following criteria:
Any microscopic assessment of regional nodes (including FNA, incisional core
needle bx, excisional bx, sentinel node bx or node resection), WITH
removal of the primary site adequate for pathologic T classification
(treatment) or biopsy assessment of the highest T category.
OR
Any microscopic assessment of a regional node in the highest N category,
regardless of the T category information.
p
5 Does not meet criteria for AJCC y-pathologic (yp) staging:
Regional lymph nodes removed for examination AFTER neoadjuvant therapy
AND lymph node evaluation based on clinical evidence, unless the
pathologic evidence at surgery (AFTER neoadjuvant) is more extensive
(see code 6).
c
6 Meets criteria for AJCC y-pathologic (yp) staging:
Regional lymph nodes removed for examination AFTER neoadjuvant therapy
AND lymph node evaluation based on pathologic evidence, because the
pathologic evidence at surgery is more extensive than clinical evidence
before treatment.
yp
8 Meets criteria for AJCC autopsy (a) staging:
Evidence from autopsy; tumor was unsuspected or undiagnosed prior to
autopsy.
a
9 Unknown if lymph nodes removed for examination
Not assessed; cannot be assessed
Unknown if assessed
Not documented in patient record
c
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Malignant Melanoma of Lower Lip
Reg LN Pos (Revised: 03/30/2009) Note: Record this field even if there has been preoperative treatment.
Code Description
00 All nodes examined negative.
01-89 1 - 89 nodes positive (code exact number of nodes positive)
90 90 or more nodes positive
95 Positive aspiration or core biopsy of lymph node(s)
97 Positive nodes - number unspecified
98 No nodes examined
99 Unknown if nodes are positive; not applicable
Not documented in patient record
Malignant Melanoma of Lower Lip
Reg LN Exam (Revised: 03/02/2009)
Code Description
00 No nodes examined
01-89 1 - 89 nodes examined (code exact number of regional lymph nodes examined)
90 90 or more nodes examined
95 No regional nodes removed, but aspiration or core biopsy of regional nodes performed
96 Regional lymph node removal documented as sampling and number of nodes unknown/not stated
97 Regional lymph node removal documented as dissection and number of nodes unknown/not stated
98 Regional lymph nodes surgically removed but number of lymph nodes unknown/not stated and not
documented as sampling or dissection; nodes examined, but number unknown
99 Unknown if nodes were examined; not applicable or negative
Not documented in patient record
Malignant Melanoma of Lower Lip
CS Mets at DX (Revised: 11/07/2009) Note: Supraclavicular and transverse cervical lymph nodes are coded in CS Lymph Nodes because they are
categorized as N rather than M in AJCC TNM.
Code Description TNM 7 TNM 6 SS77 SS2000
00 No; none M0 NA NONE NONE
10 Distant lymph node(s)
Mediastinal
Distant lymph node(s), NOS
M1 NA D D
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Code Description TNM 7 TNM 6 SS77 SS2000
40 Distant metastases except distant lymph node(s)(code
10)
Carcinomatosis
M1 NA D D
50 10 + 40)
(Distant lymph node(s) + Other distant metastases)
M1 NA D D
60 Distant metastasis, NOS
Stated as M1, NOS
M1 NA D D
99 Unknown if distant metastasis
Distant metastasis cannot be assessed
Not documented in patient record
M0 NA U U
Malignant Melanoma of Lower Lip
CS Mets Eval (Revised: 11/13/2009) Note: This item reflects the validity of the classification of the item CS Mets at DX only according to the
diagnostic methods employed.
Code Description Staging
Basis 7
Staging
Basis 6
0 Does not meet criteria for AJCC pathologic staging of distant metastasis:
Evaluation of distant metastasis based on physical examination, imaging
examination, and/or other non-invasive clinical evidence. No pathologic
examination of metastatic tissue performed or pathologic examination was
negative.
c
1 Does not meet criteria for AJCC pathologic staging of distant metastasis:
Evaluation of distant metastasis based on endoscopic examination or other
invasive technique, including surgical observation without biopsy. No
pathologic examination of metastatic tissue performed or pathologic
examination was negative.
c
2 Meets criteria for AJCC pathologic staging of distant metastasis:
No pathologic examination of metastatic specimen done prior to death, but
positive metastatic evidence derived from autopsy (tumor was suspected or
diagnosed prior to autopsy).
p
3 Meets criteria for AJCC pathologic staging of distant metastasis:
Specimen from metastatic site microscopically positive WITHOUT pre-surgical
systemic treatment or radiation
OR specimen from metastatic site microscopically positive, unknown if pre-
surgical systemic treatment or radiation performed
OR specimen from metastatic site microscopically positive prior to neoadjuvant
treatment.
p
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Code Description Staging
Basis 7
Staging
Basis 6
5 Does not meet criteria for AJCC y-pathologic (yp) staging of distant metastasis:
Specimen from metastatic site microscopically positive WITH pre-surgical
systemic treatment or radiation, BUT metastasis based on clinical
evidence.
c
6 Meets criteria for AJCC y-pathologic (yp) staging of distant metastasis:
Specimen from metastatic site microscopically positive WITH pre-surgical
systemic treatment or radiation, BUT metastasis based on pathologic
evidence.
yp
8 Meets criteria for AJCC autopsy (a) staging of distant metastasis:
Evidence from autopsy based on examination of positive metastatic tissue AND
tumor was unsuspected or undiagnosed prior to autopsy.
a
9 Not assessed; cannot be assessed
Unknown if assessed
Not documented in patient record
c
Malignant Melanoma of Lower Lip
CS Site-Specific Factor 1 Size of Lymph Nodes (Revised: 12/01/2009) Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph
node(s). Do not code the size of any nodes coded in CS Mets at DX.
Code Description
000 No involved regional nodes
001-979 001-979 millimeters (code exact size in millimeters)
980 980 millimeters or larger
981-988 OBSOLETE DATA CONVERTED V0200
See code 980
981-988 millimeters
989 OBSOLETE DATA CONVERTED V0200
See code 980
989 millimeters or larger
990 Microscopic focus or foci only, no size of focus given
991 Described as "less than 1cm"
992 Described as "less than 2cm" or "greater than 1cm" or "between 1cm and 2cm"
993 Described as "less than 3cm" or "greater than 2cm" or "between 2cm and 3cm"
994 Described as "less than 4cm" or "greater than 3cm" or "between 3cm and 4cm"
995 Described as "less than 5cm" or "greater than 4cm" or "between 4cm and 5cm"
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Code Description
996 Described as "less than 6cm" or "greater than 5cm" or "between 5cm and 6cm"
997 Described as "more than 6cm"
999 Regional lymph node(s) involved, size not stated
Unknown if regional lymph node(s) involved
Not documented in patient record
Malignant Melanoma of Lower Lip
CS Site-Specific Factor 2 OBSOLETE - Extracapsular Extension, Lymph Nodes for Head
and Neck (Revised: 12/30/2009) Note 1: This CS Site-Specific Factor is obsolete beginning with CS Version 2 (codes and notes). Old data are
retained, but new cases are not coded with this Factor. Use code 988 for this field.
Note 2: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved
regional lymph node(s) coded in the CS Lymph Nodes field. Do not code extracapsular extension in any nodes
coded in CS Mets at DX in this field.
Note 3: A statement of the presence or absence of extracasular extension in a pathology report takes priority over
clinical assessment. However, if the pathology report contains no statement about extracapsular extension, either
positive or negative, the clinical assessment should be coded. If nodes are involved but there is neither a clinical
assessment of extranodal extension nor a statement about it in the pathology report, use code 999.
Note 4: According to AJCC (page 24), "Imaging studies showing amorphous speculated margins of involved nodes
or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular
(extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such
disease."
Note 5: CS Site-Specific Factor 2 is obsolete beginning with CS Version 2 (codes and notes). Old data are retained,
but new cases are not coded with this Factor. Use code 988 for this field.
Code Description
000 OBSOLETE DATA RETAINED V0200
No extracapsular extension
001 OBSOLETE DATA RETAINED V0200
Extracapsular extension clinically, not assessed pathologically
Nodes described as "fixed", not assessed pathologically
005 OBSOLETE DATA RETAINED V0200
Extracapsular extension present pathologically
888 OBSOLETE DATA CONVERTED V0200
See code 987
Not applicable; no lymph node involvement
987 OBSOLETE DATA CONVERTED AND RETAINED V0200
Data converted from code 888
Not applicable; no lymph node involvement
988 Not applicable:
Information not collected for this case
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Code Description
999 OBSOLETE DATA RETAINED V0200
Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Malignant Melanoma of Lower Lip
CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck (Revised: 03/30/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Code Description
000 No lymph node involvement in Levels I, II, or III
100 Level I lymph node(s) involved
010 Level II lymph node(s) involved
001 Level III lymph node(s) involved
110 Level I and II lymph nodes involved
101 Level I and III lymph nodes involved
011 Level II and III lymph nodes involved
111 Level I, II and III lymph nodes involved
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Malignant Melanoma of Lower Lip
CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and
Neck (Revised: 03/30/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Code Description
000 No lymph node involvement in Levels IV or V or retropharyngeal
100 Level IV lymph node(s) involved
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Code Description
010 Level V lymph node(s) involved
001 Retropharyngeal nodes involved
110 Level IV and V lymph nodes involved
101 Level IV and retropharyngeal nodes involved
011 Level V and retropharyngeal nodes involved
111 Level IV and V and retropharyngeal lymph nodes involved
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Malignant Melanoma of Lower Lip
CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck (Revised:
03/30/2009) Note 1: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Note 2: Facial nodes including buccinator, mandibular, and nasolabial lymph nodes.
Code Description
000 No lymph node involvement in Levels VI or VII or facial nodes
100 Level VI lymph node(s) involved
010 Level VII lymph node(s) involved
001 Facial lymph node(s) involved
110 Level VI and VII lymph nodes involved
101 Level VI and facial nodes involved
011 Level VII and facial nodes involved
111 Level VI and VII and facial lymph nodes involved
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
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Malignant Melanoma of Lower Lip
CS Site-Specific Factor 6 Parapharyngeal, Parotid, and Suboccipital/Retroauricular
Lymph Nodes, Lymph Nodes for Head and Neck (Revised: 08/25/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Code Description
000 No involvement of any group:
Parapharyngeal lymph nodes
Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes
Suboccipital/retroauricular lymph nodes
100 Parapharyngeal lymph node(s) involved
010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved
001 Suboccipital/retroauricular lymph node(s) involved
110 Involvement of two groups:
Parapharyngeal lymph nodes
Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes
101 Involvement of two groups:
Parapharyngeal lymph nodes
Suboccipital/retroauricular lymph nodes
011 Involvement of two groups:
Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes
Suboccipital lymph nodes
111 Involvement of three groups:
Parapharyngeal lymph nodes
Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes
, Suboccipital/retroauricular lymph nodes
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Lip - 88 Version 02.02.00
Malignant Melanoma of Lower Lip
CS Site-Specific Factor 7 Upper and Lower Cervical Node Levels (Revised: 03/30/2009) Note 1: AJCC requires that nodes be designated as involving upper or lower levels within the neck. The boundary
between upper and lower levels is the lower border of the cricoid cartilage.
Note 2: Nodes in Levels I, II, and III are upper level nodes. Nodes in Level IV and VII are lower level nodes.
Level VA nodes are upper level nodes, and Level VB are lower level nodes. Level VI nodes span both upper and
lower levels. Nodes included in "Other groups" (Facial, Parotid, Parapharyngeal, Retropharyngeal, Retroauricular,
and Suboccipital) are all upper level nodes.
Note 3: Code the location of nodal involvement in relation to the lower border of the cricoid cartilage of all
involved nodes, whether assessed clinically or pathologically, as stated by a physician.
Note 4: If there is no physician statement of upper and/or lower level nodal involvement, assign levels I, II, III, and
VA nodes to upper level. Assign level IV, VB, and VII to lower level. If Level V (A and B not specified) and/or
Level VI nodes are involved with no further information about location, use code 040.
Note 5: A description of "mid neck" requires clarification with the physician. Code 040, unknown level, if "mid
neck" is the only information available.
Code Description
000 No lymph nodes involved
010 Upper level lymph nodes involved (all involved nodes above the lower border of the cricoid cartilage)
020 Lower level lymph nodes involved (all involved nodes below the lower border of the cricoid cartilage)
030 Upper and lower level lymph nodes involved (all involved nodes both above and below the lower
border of the cricoid cartilage)
040 Unknown level lymph nodes involved (unable to determine if involved nodes above or below the lower
border of the cricoid cartilage)
988 Not applicable:
Information not collected for this case
999 Unknown if regional lymph node(s) involved, not stated Not documented in patient record
Malignant Melanoma of Lower Lip
CS Site-Specific Factor 8 Extracapsular Extension Clinically, Lymph Nodes for Head and
Neck (Revised: 10/16/2009) Note 1: Code the status of extracapsular extension accessed clinically for any involved regional lymph node(s)
coded in the CS Lymph Nodes field. Do not code extracapsular extensio in any nodes coded in CS Mets at DX in
this field.
Note 2: If nodes are involved clinically, and documentation of physical examination or imaging is available
without a statement of extracapsular extension, use code 010.
Note 3: If the only documentation is a reference to clinically involved nodes with no reference to extracapsular
extension, use code 030.
Note 4: If there is no information about clinical assessment of nodes, use code 999.
Note 5: Clinical assessment can be by physical examination or imaging. According to AJCC, "ECS can be
diagnosed clinically by a matted mass of nodes adherent to overlying skin, adjacent soft tissue, or clinical evidence
of cranial nerve tissue. Radiologic signs of ECS include amorphous, spiculated margins of a metastatic node and
stranding of the perinodal soft tissue in previously untreated patients."
Code Description
000 No lymph nodes involved clinically
010 Nodes involved clinically, no extracapsular extension clinically
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 89 Version 02.02.00
Code Description
020 Nodes involved clinically, extracapsular extension clinically (nodes described as fixed or matted)
030 Nodes involved clinically, unknown if extracapsular extension
988 Not applicable:
Information not collected for this case
997 Clinical examination of lymph nodes performed, unknown results
998 No clinical examination of lymph nodes
999 Unknown if regional lymph node(s) involved clinically, not stated Regional lymph nodes cannot be
accessed Not documented in patient record
Malignant Melanoma of Lower Lip
CS Site-Specific Factor 9 Extracapsular Extension Pathologically, Lymph Nodes for Head
and Neck (Revised: 08/25/2009) Note 1: Code the status of extracapsular extension assessed pathologically of any involved regional lymph node(s)
coded in the CS Lymph Nodes field. Do not code extracapsular extension in any nodes coded in CS Mets at DX in
this field.
Note 2: If nodes are involved pathologically but there is no statement of extranodal extension in the pathology
report, use code 010.
Note 3: Code "microscopic" or "macroscropic" extranodal extension as stated in the final diagnosis. If not stated in
the final diagnosis, code "microscopic" if extranodal extension is described only in the microscopic section of the
pathology report and "macroscopic" if extranodal extension is described in the gross section of the pathology report.
Note 4: "Macroscopic" extension takes priority over "microscopic" extension.
Note 5: Use code 040 if pathologic extracapsular extension is described with no further information and the
pathology report is not available for review.
Note 6: Use code 050 if nodes involved pathologically with no further information about extracapsular extension.
Code Description
000 No lymph nodes involved pathologically
010 Nodes involved pathologically, no extracapsular extension pathologically
020 Nodes involved pathologically, MICROSCOPIC extracapsular extension pathologically
030 Nodes involved pathologically, MACROSCOPIC extracapsular extension pathologically
040 Nodes involved pathologically, extracapsular extension pathologically, unknown if microscopic or
macroscopic
050 Nodes involved pathologically, unknown if extracapsular extension
988 Not applicable:
Information not collected for this case
997 Pathologic examination of lymph nodes performed, results not available
998 No pathologic examination of lymph nodes
999 Unknown if regional lymph node(s) involved pathologically, not stated
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Lip - 90 Version 02.02.00
Malignant Melanoma of Lower Lip
CS Site-Specific Factor 10 HPV (Human Papilloma Virus) Status (Revised: 10/12/2009) Note 1: There is evidence that human papilloma virus (HPV) plays a role in the pathogenesis of some cancers.
Note 2: Record the results of any HPV testing performed on pathologic specimens from the primary tumor or a
metastatic site, including regional nodes. HPV testing may be performed for prognostic purposes; testing may also
be performed on metastatic sites to aid in the determination of the primary site.
Note 3: The highest risk HPV types are types 16 and 18. Other high risk types are 31, 33, 35, 36, 45, 51, 52, 56, 58,
59, 68, 26, 53, 66, 67, 69, 70, 73, 82, 85 Low risk types are 6, 11, 32, 34, 40, 42, 44, 54, 61, 62, 64, 71, 72, 74, 81,
83, 84, 87, 89. The HPV vaccine is designed to protect against types 16 and 18 (associated with cervical cancer) and
types 6 and 11 (associated with genital warts).
Note 4: High risk may be abbreviated "hrHPV" or "HR-HPV".
Note 5: Some tests for HPV, such as a hybrid capture test, only report negative or positive for high risk HPV
without identifying types; use codes 025 and 050, respectively to report those test results.
Code Description
000 HPV test negative; not positive for any HPV types
Negative, NOS
010 LOW RISK positive (all positive type(s) are low risk)
020 HIGH RISK positive, specified type(s) other than types 16 or 18,
WITH or WITHOUT positive results for low risk type(s)
030 HIGH RISK positive for HPV 16 WITHOUT positive results for HPV 18 or positivity of HPV 18
unknown,
WITH or WITHOUT positive results for other high-risk types,
WITH or WITHOUT positive results for low risk type(s)
040 HIGH RISK positive for HPV 18 WITHOUT positive results for HPV 16 or positivity of HPV 16
unknown,
WITH or WITHOUT positive results for other high-risk types,
WITH or WITHOUT positive results for low risk type(s)
050 HIGH RISK positive for HPV 16 AND HPV 18,
WITH or WITHOUT positive results for other high-risk types,
WITH or WITHOUT positive results for low risk type(s)
060 HIGH RISK positive, NOS, type(s) not specified
070 Positive, NOS, risk and type(s) not stated
988 Not applicable:
Information not collected for this case
997 Test ordered, results not in chart
998 Test not done (test was not ordered and was not performed), including no pathologic specimen
available for HPV testing
999 Unknown or no information
Not documented in patient record
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Lip - 91 Version 02.02.00
Malignant Melanoma of Lower Lip
CS Site-Specific Factor 11 Measured Thickness (Depth) (Revised: 11/15/2009) Note 1: Code MEASURED THICKNESS (Depth) of the invasive tumor not size, diameter, or any other
measurement. Record the actual measurement in tenths of millimeters as stated on the pathology repot. Do not
record the measurement from a radiographic report.
Note 2: Record the measurement labeled specifically as thickness or depth of tumor. In the absence of a label,use
the "cut surface" dimension, or the third dimension from a description of 3 dimensions (N1 x N2 x N3). For
example, from a tumor size recorded as 2cm x 1cm x 0.5cm, record 050.
Code Description
000 No mass/tumor found
001-979 Exact thickness in tenths of millimeters
Examples:
001 0.1 millimeter
010 1 millimeter
042 4.2 millimeters
100 10 millimeters, 1 centimeter
103 10.3 millimeters
980 98.0 millimeters or larger
987 Not applicable, in situ carcinoma
988 Not applicable:
Information not collected for this case
990 Microinvasion
Microscopic focus or foci only; no depth given
998 No surgical specimen
999 Not documented in patient record
Unknown, thickness not stated
Malignant Melanoma of Lower Lip
CS Site-Specific Factor 12 (Revised: 06/30/2008)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Lower Lip
CS Site-Specific Factor 13 (Revised: 06/30/2008)
Code Description
988 Not applicable for this schema
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Lip - 92 Version 02.02.00
Malignant Melanoma of Lower Lip
CS Site-Specific Factor 14 (Revised: 06/30/2008)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Lower Lip
CS Site-Specific Factor 15 (Revised: 06/30/2008)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Lower Lip
CS Site-Specific Factor 16 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Lower Lip
CS Site-Specific Factor 17 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Lower Lip
CS Site-Specific Factor 18 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Lower Lip
CS Site-Specific Factor 19 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Lower Lip
CS Site-Specific Factor 20 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 93 Version 02.02.00
Malignant Melanoma of Lower Lip
CS Site-Specific Factor 21 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Lower Lip
CS Site-Specific Factor 22 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Lower Lip
CS Site-Specific Factor 23 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Lower Lip
CS Site-Specific Factor 24 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Lower Lip
CS Site-Specific Factor 25 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Lip - 94 Version 02.02.00
Other Lip
Lip (Vermilion or Labial Mucosa)
C00.2, C00.5, C00.8-C00.9 C00.2 External lip, NOS
C00.5 Mucosa of lip, NOS
C00.8 Overlapping lesion of lip
C00.9 Lip, NOS (excludes skin of lip C44.0)
Note: AJCC includes labial mucosa (C00.5) with buccal mucosa (C06.0)
CS Tumor Size CS Extension CS Tumor Size/Ext Eval CS Lymph Nodes CS Lymph Nodes Eval Reg LN Pos Reg LN Exam CS Mets at DX CS Mets Eval
CS Site-Specific Factor 1 Size of Lymph Nodes CS Site-Specific Factor 2 OBSOLETE -
Extracapsular Extension, Lymph Nodes for
Head and Neck CS Site-Specific Factor 3 Levels I-III, Lymph
Nodes for Head and Neck CS Site-Specific Factor 4 Levels IV-V and
Retropharyngeal Lymph Nodes for Head and
Neck CS Site-Specific Factor 5 Levels VI-VII and
Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 Parapharyngeal,
Parotid, and Suboccipital/Retroauricular Lymph
Nodes, Lymph Nodes for Head and Neck CS Site-Specific Factor 7 Upper and Lower
Cervical Node Levels CS Site-Specific Factor 8 Extracapsular
Extension Clinically, Lymph Nodes for Head
and Neck CS Site-Specific Factor 9 Extracapsular
Extension Pathologically, Lymph Nodes for
Head and Neck CS Site-Specific Factor 10 HPV (Human
Papilloma Virus) Status CS Site-Specific Factor 11 Measured Thickness
(Depth) CS Site-Specific Factor 12 CS Site-Specific Factor 13 CS Site-Specific Factor 14 CS Site-Specific Factor 15 CS Site-Specific Factor 16 CS Site-Specific Factor 17 CS Site-Specific Factor 18 CS Site-Specific Factor 19 CS Site-Specific Factor 20 CS Site-Specific Factor 21 CS Site-Specific Factor 22 CS Site-Specific Factor 23 CS Site-Specific Factor 24 CS Site-Specific Factor 25
The following tables are
available at the collaborative
staging website:
Histology Inclusion Table
AJCC 7th ed. Histology Exclusion Table
AJCC 6th ed. AJCC TNM 7 Stage AJCC TNM 6 Stage Summary Stage Extension Size Table Lymph Nodes Size Table
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Lip - 95 Version 02.02.00
Other Lip
CS Tumor Size (Revised: 10/18/2009) Note 1: Code the specific tumor size as stated in the medical record. Use code 992, 994, or 995 if the physician's
statement about T value is the ONLY information available about the size of the tumor. (Refer to the CS Extension
table for instructions on coding extension.)
Code Description
000 No mass/tumor found
001-988 001 - 988 millimeters (code exact size in millimeters)
989 989 millimeters or larger
990 Microscopic focus or foci only, no size of focus given
991 Described as "less than 1 cm"
992 Described as "less than 2 cm," or "greater than 1 cm," or "between 1 cm and 2 cm"
Stated as T1 with no other information on size
993 Described as "less than 3 cm," or "greater than 2 cm," or "between 2 cm and 3 cm"
994 Described as "less than 4 cm," or "greater than 3 cm," or "between 3 cm and 4 cm"
Stated as T2 with no other information on size
995 Described as "less than 5 cm," or "greater than 4 cm," or "between 4 cm and 5 cm"
Stated as T3 with no other information on size
996 Described as "greater than 5cm"
999 Unknown; size not stated
Not documented in patient record
Other Lip
CS Extension (Revised: 10/23/2009) Note 1: Periosteum is a fibrous membrane that wraps the outer surface of bones. Cortical bone is the dense
compact outer layer of bone. Trabecular, cancellous, or spongy bone (spongiosa) is a porous network of tissue filling
the interior of bone, decreasing weight and allowing room for blood vessels and marrow.
Note 2: AJCC assigns T value based on size when bone involvement is limited to the cortex. Involvement through
cortical bone is required for assignment of T4a.
Note 3: Use code 300 for localized tumor ONLY if no information is available to assign codes 100, 200, 405, 410,
or 415.
Note 4: Use codes 405, 410, 415, 778, 810, or 815 if the physician's assignment of T category is the ONLY
information available about the extent of the tumor.
Code Description TNM 7 TNM 6 SS77 SS2000
000 In situ; noninvasive; intraepithelial Tis Tis IS IS
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 96 Version 02.02.00
Code Description TNM 7 TNM 6 SS77 SS2000
100 Invasive tumor confined to:
Labial mucosa (inner lip)
Lamina propria
Multiple foci
Submucosa (superficial invasion)
Vermilion surface
Superficial extension to:
Skin of lip
Subcutaneous soft tissue of lip
^ * L L
200 Musculature ^ * L L
300 Localized, NOS ^ * L L
405 Stated as T1 with no other information on extension ^ * L L
410 Stated as T2 with no other information on extension ^ * L L
415 Stated as T3 with no other information on extension ^ * L L
500 Buccal mucosa (inner cheek)
Commissure
Opposite (both) lip(s)
^ * RE RE
510 Gingiva ^ * RE RE
535 Cortical bone of maxilla
Maxilla, NOS
Cortical bone of mandible
Mandible, NOS
Cortical bone, NOS (not specified in higher codes)
Bone, NOS (not specified in higher codes)
^ * RE RE
725 Trabecular bone of maxilla or mandible T4a T4a RE RE
740 Nose T4a T4a RE D
750 Tongue T4a T4a D D
760 Skin of face/neck T4a T4a D D
770 OBSOLETE DATA RETAINED V0200
Cortical bone
Floor of mouth
Inferior alveolar nerve
ERROR T4a D D
778 Stated as T4a with no other information on extension T4a T4a RE RE
788 Specified bone (other than mandible, maxilla, or bones
in codes 790 and 800)
T4b T4b D D
790 Masticator space
Pterygoid plates
T4b T4b D D
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 97 Version 02.02.00
Code Description TNM 7 TNM 6 SS77 SS2000
800 Further contiguous extension including:
Skull base
Internal carotid artery (encased)
T4b T4b D D
810 Stated as T4b with no other information on extension T4b T4b D D
815 Stated as T4 NOS with no other information on
extension
T4NOS T4NOS RE RE
950 No evidence of primary tumor T0 T0 U U
999 Unknown extension
Primary tumor cannot be assessed
Not documented in patient record
TX TX U U
^ For Extension codes 100 through 535 ONLY, the T category for AJCC 7th Edition staging is assigned based on
the value of CS Tumor Size, as shown in the Extension Size Table for this site.
* For Extension codes 100 through 535 ONLY, the T category for AJCC 6th Edition staging is assigned based on
the value of CS Tumor Size, as shown in the Extension Size Table for this site.
Other Lip
CS Tumor Size/Ext Eval (Revised: 08/10/2009)
Code Description Staging
Basis
0 Does not meet criteria for AJCC pathologic staging:
No surgical resection done. Evaluation based on physical examination, imaging
examination, or other non-invasive clinical evidence. No autopsy evidence used.
c
1 Does not meet criteria for AJCC pathologic staging:
No surgical resection done. Evaluation based on endoscopic examination, diagnostic
biopsy, including fine needle aspiration biopsy, or other invasive techniques, including
surgical observation without biopsy. No autopsy evidence used.
c
2 Meets criteria for AJCC pathologic staging:
No surgical resection done, but evidence derived from autopsy (tumor was suspected or
diagnosed prior to autopsy)
p
3 Either criteria meets AJCC pathologic staging:
Surgical resection performed WITHOUT pre-surgical systemic treatment or radiation
OR surgical resection performed, unknown if pre-surgical systemic treatment or radiation
performed
AND Evaluation based on evidence acquired before treatment, supplemented or modified
by the additional evidence acquired during and from surgery, particularly from
pathologic examination of the resected specimen.
No surgical resection done. Evaluation based on positive biopsy of highest T classification.
p
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 98 Version 02.02.00
Code Description Staging
Basis
5 Does not meet criteria for AJCC y-pathologic (yp) staging:
Surgical resection performed AFTER neoadjuvant therapy and tumor size/extension based
on clinical evidence, unless the pathologic evidence at surgery (AFTER neoadjuvant)
is more extensive (see code 6).
c
6 Meets criteria for AJCC y-pathologic (yp) staging:
Surgical resection performed AFTER neoadjuvant therapy AND tumor size/extension
based on pathologic evidence, because pathologic evidence at surgery is more
extensive than clinical evidence before treatment.
yp
8 Meets criteria for autopsy (a) staging:
Evidence from autopsy only (tumor was unsuspected or undiagnosed prior to autopsy)
a
9 Unknown if surgical resection done
Not assessed; cannot be assessed
Unknown if assessed
Not documented in patient record
c
Other Lip
CS Lymph Nodes (Revised: 07/26/2009) Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by
AJCC. The complete definitions are provided in the General Instructions.
Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes,
extracapsular extension, levels involved, and location of involved nodes above or below the lower border of the
cricoid cartilage) is coded in Site-Specific Factors 1, 3-9.
Note 3: If laterality of lymph nodes is not specified, assume nodes are ipsilateral. Midline nodes are considered
ipsilateral.
Note 4: For head and neck cancers, if lymph nodes are described only as "supraclavicular", try to determine if they
are in Level IV (deep to the sternocleidomastoid muscle, in the lower jugular chain) or Level V (in the posterior
triangle, inferior to the transverse cervical artery) and code appropriately. If the specific level cannot be determined,
consider them as Level V nodes.
Note 5: The description of lymph nodes has been standardized across the head and neck schemas. All lymph node
levels and groups listed here are considered regional nodes for AJCC staging. Summary Stage 1977 and Summary
Stage 2000 divide these nodes into regional and distant groups.
Code Description TNM 7 TNM 6 SS77 SS2000
000 None; no regional lymph node involvement N0 N0 NONE NONE
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 99 Version 02.02.00
Code Description TNM 7 TNM 6 SS77 SS2000
100 Single positive ipsilateral regional node:
Level I node:
Level IA - Submental
Level IB - Submandibular (submaxillary),
sublingual
Other groups
Facial
Buccinator (buccal)
Mandibular
Nasolabial
Parotid
Infraauricular
Intraparotid
Periparotid
Preauricular
Regional lymph node, NOS
^ * RN RN
110 Single positive ipsilateral regional node:
Level II node - Upper jugular
Jugolodigastric (subdigastric)
Upper deep cervical
Level III node - Middle jugular
Middle deep cervical
Level IV node - Lower jugular
Jugulo-omohyoid (supraomohyoid)
Lower deep cervical
Virchow node
Cervical, NOS
Deep cervical, NOS
Internal jugular, NOS
^ * D RN
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 100 Version 02.02.00
Code Description TNM 7 TNM 6 SS77 SS2000
120 Single positive ipsilateral regional node:
Level V node - Posterior triangle group
Posterior cervical
Level VA - Spinal accessory
Level VB - Transverse cervical,
supraclavicular (see note 4)
Level VI node - Anterior compartgment group
Laterotracheal
Paralaryngeal
Paratracheal - above suprasternal notch
Perithyroidal
Precricoid (Delphian)
Prelaryngeal
Pretracheal - above suprasternal notch
Recurrent laryngeal
Level VII node - Superior mediastinal group (for
other mediastinal nodes see CS Mets at DX)
Esophageal groove
Paratracheal - below suprasternal notch
Pretracheal - below suprasternal notch
Other groups:
Parapharyngeal
Retroauricular
Retropharyngeal
Suboccipital
^ * D D
180 Stated as N1, no other information N1 N1 RN RN
190 Stated as N2a, no other information N2a N2a RN RN
200 Multiple positive ipsilateral nodes listed in code 100 ^ * RN RN
210 Multiple positive ipsilateral nodes, any listed in code
110 (WITH or WITHOUT any nodes listed in code
100)
^ * D RN
220 Multiple positive ipsilateral nodes, any listed in code
120 (WITH or WITHOUT any nodes listed in code
100, 110)
^ * D D
290 Stated as N2b, no other information N2b N2b RN RN
300 Regional lymph nodes listed in code 100:
Positive ipsilateral node(s), not stated if single or
multiple
^ * RN RN
310 Regional lymph nodes listed in code 110:
Positive ipsilateral node(s), not stated if single or
multiple
^ * D RN
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 101 Version 02.02.00
Code Description TNM 7 TNM 6 SS77 SS2000
320 Regional lymph nodes listed in code 120:
Positive ipsilateral node(s), not stated if single or
multiple
^ * D D
400 Regional lymph nodes listed in code 100:
Positive bilateral or contralateral nodes
^ * RN RN
410 Regional lymph nodes, any listed in code 110:
Positive bilateral or contralateral nodes (WITH or
WITHOUT any nodes listed in code 100)
^ * D RN
420 Regional lymph nodes, any listed in code 120:
Positive bilateral or contralateral nodes (WITH or
WITHOUT any nodes listed in codes 100, 110)
^ * D D
490 Stated as N2c, no other information N2c N2c RN RN
500 Regional lymph nodes listed in code 100:
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral,
AND not stated if single or multiple
^ * RN RN
510 Regional lymph nodes listed in code 110:
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral,
AND not stated if single or multiple
^ * D RN
520 Regional lymph nodes listed in code 120:
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral,
AND not stated if single or multiple
^ * D D
600 Stated as N2, NOS N2NOS N2NOS RN RN
700 Stated as N3, no other information N3 N3 RN RN
800 Lymph nodes, NOS, no other information ^ * RN RN
999 Unknown; not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
NX NX U U
^ For codes 100-120, 200-220, 300-320, 400-420, 500-520, and 800 ONLY, the N category for AJCC 7th Edition
staging is assigned based on the value of Site-Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph
Nodes Size Table, for this site.
* For codes 100-120, 200-220, 300-320, 400-420, 500-520, and 800 ONLY, the N category for AJCC 6th Edition
staging is assigned based on the value of Site-Specific Factor 1, Size of Lymph Nodes, using the extra table, Lymph
Nodes Size Table, for this site.
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Other Lip
CS Lymph Nodes Eval (Revised: 10/26/2009) Note 1: This field is used primarily to derive the staging basis for the N category in the TNM system. It records
how the code for the item "CS Lymph Nodes" was determined based on the diagnostic methods employed and their
intent.
Note 2: In the 7th edition of the AJCC manual, the clinical and pathologic classification rules for the N category were
changed to reflect current medical practice. The N is designated as clinical or pathologic based on the intent
(workup versus treatment) matching with the assessment of the T classification. When the intent is workup, the
staging basis is clinical, and when the intent is treatment, the staging basis is pathologic.
A. Microscopic assessment including biopsy of regional nodes or sentinel nodes if being performed as part of
the workup to choose the treatment plan, is therefore part of the clinical staging. When it is part of the workup, the
T category is clinical, and there has not been a resection of the primary site adequate for pathologic T classification
(which would be part of the treatment).
B. Microscopic assessment of regional nodes if being performed as part of the treatment is therefore part of the
pathologic staging. When it is part of the treatment, the T category is pathologic, and there has been a resection of
the primary site adequate for pathologic T classification (all part of the treatment).
Note 3: Microscopic assessment of the highest N category is always pathologic (code 3).
Note 4: If lymph node dissection is not performed after neoadjuvant therapy, use code 0 or 1.
Note 5: Only codes 5 and 6 are used if the node assessment is performed after neoadjuvant therapy.
Code Description Staging
Basis
0 Does not meet criteria for AJCC pathologic staging:
No regional lymph nodes removed for examination. Evidence based on physical
examination, imaging examination, or other non-invasive clinical evidence. No
autopsy evidence used.
c
1 Does not meet criteria for AJCC pathologic staging based on at least one of the following
criteria:
No regional lymph nodes removed for examination. Evidence based on endoscopic
examination, or other invasive techniques including surgical observation, without
biopsy. No autopsy evidence used.
OR
Fine needle aspiration, incisional core needle biopsy, or excisional biopsy of regional
lymph nodes or sentinel nodes as part of the diagnostic workup, WITHOUT removal
of the primary site adequate for pathologic T classification (treatment).
c
2 Meets criteria for AJCC pathologic staging:
No regional lymph nodes removed for examination, but evidence derived from autopsy
(tumor was suspected or diagnosed prior to autopsy).
p
3 Meets criteria for AJCC pathologic staging based on at least one of the following criteria:
Any microscopic assessment of regional nodes (including FNA, incisional core needle bx,
excisional bx, sentinel node bx or node resection), WITH removal of the primary site
adequate for pathologic T classification (treatment) or biopsy assessment of the highest
T category.
OR
Any microscopic assessment of a regional node in the highest N category, regardless of the
T category information.
p
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Code Description Staging
Basis
5 Does not meet criteria for AJCC y-pathologic (yp) staging:
Regional lymph nodes removed for examination AFTER neoadjuvant therapy AND lymph
node evaluation based on clinical evidence, unless the pathologic evidence at surgery
(AFTER neoadjuvant) is more extensive (see code 6).
c
6 Meets criteria for AJCC y-pathologic (yp) staging:
Regional lymph nodes removed for examination AFTER neoadjuvant therapy AND lymph
node evaluation based on pathologic evidence, because the pathologic evidence at
surgery is more extensive than clinical evidence before treatment.
yp
8 Meets criteria for AJCC autopsy (a) staging:
Evidence from autopsy; tumor was unsuspected or undiagnosed prior to autopsy.
a
9 Unknown if lymph nodes removed for examination
Not assessed; cannot be assessed
Unknown if assessed
Not documented in patient record
c
Other Lip
Reg LN Pos (Revised: 03/30/2009) Note: Record this field even if there has been preoperative treatment.
Code Description
00 All nodes examined negative.
01-89 1 - 89 nodes positive (code exact number of nodes positive)
90 90 or more nodes positive
95 Positive aspiration or core biopsy of lymph node(s)
97 Positive nodes - number unspecified
98 No nodes examined
99 Unknown if nodes are positive; not applicable
Not documented in patient record
Other Lip
Reg LN Exam (Revised: 03/02/2009)
Code Description
00 No nodes examined
01-89 1 - 89 nodes examined (code exact number of regional lymph nodes examined)
90 90 or more nodes examined
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Code Description
95 No regional nodes removed, but aspiration or core biopsy of regional nodes performed
96 Regional lymph node removal documented as sampling and number of nodes unknown/not stated
97 Regional lymph node removal documented as dissection and number of nodes unknown/not stated
98 Regional lymph nodes surgically removed but number of lymph nodes unknown/not stated and not
documented as sampling or dissection; nodes examined, but number unknown
99 Unknown if nodes were examined; not applicable or negative
Not documented in patient record
Other Lip
CS Mets at DX (Revised: 07/23/2009) Note: Supraclavicular and transverse cervical lymph nodes are coded in CS Lymph Nodes because they are
categorized as N rather than M in AJCC TNM.
Code Description TNM 7 TNM 6 SS77 SS2000
00 No; none M0 M0 NONE NONE
10 Distant lymph node(s)
Mediastinal
Distant lymph node(s), NOS
M1 M1 D D
40 Distant metastases except distant lymph node(s)(code
10)
Carcinomatosis
M1 M1 D D
50 (10) + (40)
Distant lymph node(s) plus other distant metastases
M1 M1 D D
60 Distant metastasis, NOS
Stated as M1, NOS
M1 M1 D D
99 Unknown if distant metastasis
Distant metastasis cannot be assessed
Not documented in patient record
M0 MX U U
Other Lip
CS Mets Eval (Revised: 08/10/2009) Note: This item reflects the validity of the classification of the item CS Mets at DX only according to the
diagnostic methods employed.
Code Description Staging
Basis
0 Does not meet criteria for AJCC pathologic staging of distant metastasis:
Evaluation of distant metastasis based on physical examination, imaging examination,
and/or other non-invasive clinical evidence. No pathologic examination of metastatic
tissue performed or pathologic examination was negative.
c
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Code Description Staging
Basis
1 Does not meet criteria for AJCC pathologic staging of distant metastasis:
Evaluation of distant metastasis based on endoscopic examination or other invasive
technique, including surgical observation without biopsy. No pathologic examination
of metastatic tissue performed or pathologic examination was negative.
c
2 Meets criteria for AJCC pathologic staging of distant metastasis:
No pathologic examination of metastatic specimen done prior to death, but positive
metastatic evidence derived from autopsy (tumor was suspected or diagnosed prior to
autopsy).
p
3 Meets criteria for AJCC pathologic staging of distant metastasis:
Specimen from metastatic site microscopically positive WITHOUT pre-surgical systemic
treatment or radiation
OR specimen from metastatic site microscopically positive, unknown if pre-surgical
systemic treatment or radiation performed
OR specimen from metastatic site microscopically positive prior to neoadjuvant treatment.
p
5 Does not meet criteria for AJCC y-pathologic (yp) staging of distant metastasis:
Specimen from metastatic site microscopically positive WITH pre-surgical systemic
treatment or radiation, BUT metastasis based on clinical evidence.
c
6 Meets criteria for AJCC y-pathologic (yp) staging of distant metastasis:
Specimen from metastatic site microscopically positive WITH pre-surgical systemic
treatment or radiation, BUT metastasis based on pathologic evidence.
yp
8 Meets criteria for AJCC autopsy (a) staging of distant metastasis:
Evidence from autopsy based on examination of positive metastatic tissue AND tumor was
unsuspected or undiagnosed prior to autopsy.
a
9 Not assessed; cannot be assessed
Unknown if assessed
Not documented in patient record
c
Other Lip
CS Site-Specific Factor 1 Size of Lymph Nodes (Revised: 12/01/2009) Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph
node(s). Do not code the size of any nodes coded in CS Mets at DX.
Code Description
000 No involved regional nodes
001-979 001-979 millimeters (code exact size in millimeters)
980 980 millimeters or larger
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Code Description
981-988 OBSOLETE DATA CONVERTED V0200
See code 980
981-988 millimeters
989 OBSOLETE DATA CONVERTED V0200
See code 980
989 millimeters or larger
990 Microscopic focus or foci only, no size of focus given
991 Described as "less than 1cm"
992 Described as "less than 2cm" or "greater than 1cm" or "between 1cm and 2cm"
993 Described as "less than 3cm" or "greater than 2cm" or "between 2cm and 3cm"
994 Described as "less than 4cm" or "greater than 3cm" or "between 3cm and 4cm"
995 Described as "less than 5cm" or "greater than 4cm" or "between 4cm and 5cm"
996 Described as "less than 6cm" or "greater than 5cm" or "between 5cm and 6cm"
997 Described as "more than 6cm"
999 Regional lymph node(s) involved, size not stated
Unknown if regional lymph node(s) involved
Not documented in patient record
Other Lip
CS Site-Specific Factor 2 OBSOLETE - Extracapsular Extension, Lymph Nodes for Head
and Neck (Revised: 12/30/2009) Note 1: This CS Site-Specific Factor is obsolete beginning with CS Version 2 (codes and notes). Old data are
retained, but new cases are not coded with this Factor. Use code 988 for this field.
Note 2: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved
regional lymph node(s) coded in the CS Lymph Nodes field. Do not code extracapsular extension in any nodes
coded in CS Mets at DX in this field.
Note 3: A statement of the presence or absence of extracasular extension in a pathology report takes priority over
clinical assessment. However, if the pathology report contains no statement about extracapsular extension, either
positive or negative, the clinical assessment should be coded. If nodes are involved but there is neither a clinical
assessment of extranodal extension nor a statement about it in the pathology report, use code 999.
Note 4: According to AJCC (page 24), "Imaging studies showing amorphous speculated margins of involved nodes
or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular
(extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such
disease."
Note 5: CS Site-Specific Factor 2 is obsolete beginning with CS Version 2 (codes and notes). Old data are retained,
but new cases are not coded with this Factor. Use code 988 for this field.
Code Description
000 OBSOLETE DATA RETAINED V0200
No extracapsular extension
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Code Description
001 OBSOLETE DATA RETAINED V0200
Extracapsular extension clinically, not assessed pathologically
Nodes described as "fixed", not assessed pathologically
005 OBSOLETE DATA RETAINED V0200
Extracapsular extension present pathologically
888 OBSOLETE DATA CONVERTED V0200
See code 987
Not applicable; no lymph node involvement
987 OBSOLETE DATA CONVERTED AND RETAINED V0200
Data converted from code 888
Not applicable; no lymph node involvement
988 Not applicable:
Information not collected for this case
999 OBSOLETE DATA RETAINED V0200
Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Other Lip
CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck (Revised: 03/30/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Code Description
000 No lymph node involvement in Levels I, II, or III
100 Level I lymph node(s) involved
010 Level II lymph node(s) involved
001 Level III lymph node(s) involved
110 Level I and II lymph nodes involved
101 Level I and III lymph nodes involved
011 Level II and III lymph nodes involved
111 Level I, II and III lymph nodes involved
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Code Description
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Other Lip
CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and
Neck (Revised: 03/30/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Code Description
000 No lymph node involvement in Levels IV or V or retropharyngeal
100 Level IV lymph node(s) involved
010 Level V lymph node(s) involved
001 Retropharyngeal nodes involved
110 Level IV and V lymph nodes involved
101 Level IV and retropharyngeal nodes involved
011 Level V and retropharyngeal nodes involved
111 Level IV and V and retropharyngeal lymph nodes involved
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Other Lip
CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck (Revised:
03/30/2009) Note 1: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Note 2: Facial nodes including buccinator, mandibular, and nasolabial lymph nodes.
Code Description
000 No lymph node involvement in Levels VI or VII or facial nodes
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Code Description
100 Level VI lymph node(s) involved
010 Level VII lymph node(s) involved
001 Facial lymph node(s) involved
110 Level VI and VII lymph nodes involved
101 Level VI and facial nodes involved
011 Level VII and facial nodes involved
111 Level VI and VII and facial lymph nodes involved
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Other Lip
CS Site-Specific Factor 6 Parapharyngeal, Parotid, and Suboccipital/Retroauricular
Lymph Nodes, Lymph Nodes for Head and Neck (Revised: 08/25/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Code Description
000 No involvement of any group:
Parapharyngeal lymph nodes
Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes
Suboccipital/retroauricular lymph nodes
100 Parapharyngeal lymph node(s) involved
010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved
001 Suboccipital/retroauricular lymph node(s) involved
110 Involvement of two groups:
Parapharyngeal lymph nodes
Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes
101 Involvement of two groups:
Parapharyngeal lymph nodes
Suboccipital/retroauricular lymph nodes
011 Involvement of two groups:
Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes
Suboccipital lymph nodes
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Code Description
111 Involvement of three groups:
Parapharyngeal lymph nodes
Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes
, Suboccipital/retroauricular lymph nodes
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Other Lip
CS Site-Specific Factor 7 Upper and Lower Cervical Node Levels (Revised: 03/30/2009) Note 1: AJCC requires that nodes be designated as involving upper or lower levels within the neck. The boundary
between upper and lower levels is the lower border of the cricoid cartilage.
Note 2: Nodes in Levels I, II, and III are upper level nodes. Nodes in Level IV and VII are lower level nodes.
Level VA nodes are upper level nodes, and Level VB are lower level nodes. Level VI nodes span both upper and
lower levels. Nodes included in "Other groups" (Facial, Parotid, Parapharyngeal, Retropharyngeal, Retroauricular,
and Suboccipital) are all upper level nodes.
Note 3: Code the location of nodal involvement in relation to the lower border of the cricoid cartilage of all
involved nodes, whether assessed clinically or pathologically, as stated by a physician.
Note 4: If there is no physician statement of upper and/or lower level nodal involvement, assign levels I, II, III, and
VA nodes to upper level. Assign level IV, VB, and VII to lower level. If Level V (A and B not specified) and/or
Level VI nodes are involved with no further information about location, use code 040.
Note 5: A description of "mid neck" requires clarification with the physician. Code 040, unknown level, if "mid
neck" is the only information available.
Code Description
000 No lymph nodes involved
010 Upper level lymph nodes involved (all involved nodes above the lower border of the cricoid cartilage)
020 Lower level lymph nodes involved (all involved nodes below the lower border of the cricoid cartilage)
030 Upper and lower level lymph nodes involved (all involved nodes both above and below the lower
border of the cricoid cartilage)
040 Unknown level lymph nodes involved (unable to determine if involved nodes above or below the lower
border of the cricoid cartilage)
988 Not applicable:
Information not collected for this case
999 Unknown if regional lymph node(s) involved, not stated Not documented in patient record
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CS Site-Specific Factor 8 Extracapsular Extension Clinically, Lymph Nodes for Head and
Neck (Revised: 10/16/2009) Note 1: Code the status of extracapsular extension accessed clinically for any involved regional lymph node(s)
coded in the CS Lymph Nodes field. Do not code extracapsular extensio in any nodes coded in CS Mets at DX in
this field.
Note 2: If nodes are involved clinically, and documentation of physical examination or imaging is available
without a statement of extracapsular extension, use code 010.
Note 3: If the only documentation is a reference to clinically involved nodes with no reference to extracapsular
extension, use code 030.
Note 4: If there is no information about clinical assessment of nodes, use code 999.
Note 5: Clinical assessment can be by physical examination or imaging. According to AJCC, "ECS can be
diagnosed clinically by a matted mass of nodes adherent to overlying skin, adjacent soft tissue, or clinical evidence
of cranial nerve tissue. Radiologic signs of ECS include amorphous, spiculated margins of a metastatic node and
stranding of the perinodal soft tissue in previously untreated patients."
Code Description
000 No lymph nodes involved clinically
010 Nodes involved clinically, no extracapsular extension clinically
020 Nodes involved clinically, extracapsular extension clinically (nodes described as fixed or matted)
030 Nodes involved clinically, unknown if extracapsular extension
988 Not applicable:
Information not collected for this case
997 Clinical examination of lymph nodes performed, unknown results
998 No clinical examination of lymph nodes
999 Unknown if regional lymph node(s) involved clinically, not stated Regional lymph nodes cannot be
accessed Not documented in patient record
Other Lip
CS Site-Specific Factor 9 Extracapsular Extension Pathologically, Lymph Nodes for Head
and Neck (Revised: 08/25/2009) Note 1: Code the status of extracapsular extension assessed pathologically of any involved regional lymph node(s)
coded in the CS Lymph Nodes field. Do not code extracapsular extension in any nodes coded in CS Mets at DX in
this field.
Note 2: If nodes are involved pathologically but there is no statement of extranodal extension in the pathology
report, use code 010.
Note 3: Code "microscopic" or "macroscropic" extranodal extension as stated in the final diagnosis. If not stated in
the final diagnosis, code "microscopic" if extranodal extension is described only in the microscopic section of the
pathology report and "macroscopic" if extranodal extension is described in the gross section of the pathology report.
Note 4: "Macroscopic" extension takes priority over "microscopic" extension.
Note 5: Use code 040 if pathologic extracapsular extension is described with no further information and the
pathology report is not available for review.
Note 6: Use code 050 if nodes involved pathologically with no further information about extracapsular extension.
Code Description
000 No lymph nodes involved pathologically
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Code Description
010 Nodes involved pathologically, no extracapsular extension pathologically
020 Nodes involved pathologically, MICROSCOPIC extracapsular extension pathologically
030 Nodes involved pathologically, MACROSCOPIC extracapsular extension pathologically
040 Nodes involved pathologically, extracapsular extension pathologically, unknown if microscopic or
macroscopic
050 Nodes involved pathologically, unknown if extracapsular extension
988 Not applicable:
Information not collected for this case
997 Pathologic examination of lymph nodes performed, results not available
998 No pathologic examination of lymph nodes
999 Unknown if regional lymph node(s) involved pathologically, not stated
Other Lip
CS Site-Specific Factor 10 HPV (Human Papilloma Virus) Status (Revised: 10/12/2009) Note 1: There is evidence that human papilloma virus (HPV) plays a role in the pathogenesis of some cancers.
Note 2: Record the results of any HPV testing performed on pathologic specimens from the primary tumor or a
metastatic site, including regional nodes. HPV testing may be performed for prognostic purposes; testing may also
be performed on metastatic sites to aid in the determination of the primary site.
Note 3: The highest risk HPV types are types 16 and 18. Other high risk types are 31, 33, 35, 36, 45, 51, 52, 56, 58,
59, 68, 26, 53, 66, 67, 69, 70, 73, 82, 85 Low risk types are 6, 11, 32, 34, 40, 42, 44, 54, 61, 62, 64, 71, 72, 74, 81,
83, 84, 87, 89. The HPV vaccine is designed to protect against types 16 and 18 (associated with cervical cancer) and
types 6 and 11 (associated with genital warts).
Note 4: High risk may be abbreviated "hrHPV" or "HR-HPV".
Note 5: Some tests for HPV, such as a hybrid capture test, only report negative or positive for high risk HPV
without identifying types; use codes 025 and 050, respectively to report those test results.
Code Description
000 HPV test negative; not positive for any HPV types
Negative, NOS
010 LOW RISK positive (all positive type(s) are low risk)
020 HIGH RISK positive, specified type(s) other than types 16 or 18,
WITH or WITHOUT positive results for low risk type(s)
030 HIGH RISK positive for HPV 16 WITHOUT positive results for HPV 18 or positivity of HPV 18
unknown,
WITH or WITHOUT positive results for other high-risk types,
WITH or WITHOUT positive results for low risk type(s)
040 HIGH RISK positive for HPV 18 WITHOUT positive results for HPV 16 or positivity of HPV 16
unknown,
WITH or WITHOUT positive results for other high-risk types,
WITH or WITHOUT positive results for low risk type(s)
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Code Description
050 HIGH RISK positive for HPV 16 AND HPV 18,
WITH or WITHOUT positive results for other high-risk types,
WITH or WITHOUT positive results for low risk type(s)
060 HIGH RISK positive, NOS, type(s) not specified
070 Positive, NOS, risk and type(s) not stated
988 Not applicable:
Information not collected for this case
997 Test ordered, results not in chart
998 Test not done (test was not ordered and was not performed), including no pathologic specimen
available for HPV testing
999 Unknown or no information
Not documented in patient record
Other Lip
CS Site-Specific Factor 11 Measured Thickness (Depth) (Revised: 11/15/2009) Note 1: Code MEASURED THICKNESS (Depth) of the invasive tumor not size, diameter, or any other
measurement. Record the actual measurement in tenths of millimeters as stated on the pathology repot. Do not
record the measurement from a radiographic report.
Note 2: Record the measurement labeled specifically as thickness or depth of tumor. In the absence of a label,use
the "cut surface" dimension, or the third dimension from a description of 3 dimensions (N1 x N2 x N3). For
example, from a tumor size recorded as 2cm x 1cm x 0.5cm, record 050.
Code Description
000 No mass/tumor found
001-979 Exact thickness in tenths of millimeters
Examples:
001 0.1 millimeter
010 1 millimeter
042 4.2 millimeters
100 10 millimeters, 1 centimeter
103 10.3 millimeters
980 98.0 millimeters or larger
987 Not applicable, in situ carcinoma
988 Not applicable:
Information not collected for this case
990 Microinvasion
Microscopic focus or foci only; no depth given
998 No surgical specimen
999 Not documented in patient record
Unknown, thickness not stated
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Other Lip
CS Site-Specific Factor 12 (Revised: 06/30/2008)
Code Description
988 Not applicable for this schema
Other Lip
CS Site-Specific Factor 13 (Revised: 06/30/2008)
Code Description
988 Not applicable for this schema
Other Lip
CS Site-Specific Factor 14 (Revised: 06/30/2008)
Code Description
988 Not applicable for this schema
Other Lip
CS Site-Specific Factor 15 (Revised: 06/30/2008)
Code Description
988 Not applicable for this schema
Other Lip
CS Site-Specific Factor 16 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Other Lip
CS Site-Specific Factor 17 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Other Lip
CS Site-Specific Factor 18 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
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Other Lip
CS Site-Specific Factor 19 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Other Lip
CS Site-Specific Factor 20 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Other Lip
CS Site-Specific Factor 21 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Other Lip
CS Site-Specific Factor 22 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Other Lip
CS Site-Specific Factor 23 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Other Lip
CS Site-Specific Factor 24 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Other Lip
CS Site-Specific Factor 25 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
29 April 2010 Part II - Lip - 116 Version 02.02.00
Malignant Melanoma of Other Lip
Lip (Vermilion or Labial Mucosa)
C00.2, C00.5, C00.8-C00.9 (M-8720-8790)
C00.2 External lip, NOS
C00.5 Mucosa of lip, NOS
C00.8 Overlapping lesion of lip
C00.9 Lip, NOS (excludes skin of lip C44.0)
Note: AJCC includes labial mucosa (C00.5) with buccal mucosa (C06.0)
CS Tumor Size CS Extension CS Tumor Size/Ext Eval CS Lymph Nodes CS Lymph Nodes Eval Reg LN Pos Reg LN Exam CS Mets at DX CS Mets Eval
CS Site-Specific Factor 1 Size of Lymph Nodes CS Site-Specific Factor 2 OBSOLETE -
Extracapsular Extension, Lymph Nodes for
Head and Neck CS Site-Specific Factor 3 Levels I-III, Lymph
Nodes for Head and Neck CS Site-Specific Factor 4 Levels IV-V and
Retropharyngeal Lymph Nodes for Head and
Neck CS Site-Specific Factor 5 Levels VI-VII and
Facial Lymph Nodes for Head and Neck CS Site-Specific Factor 6 Parapharyngeal,
Parotid, and Suboccipital/Retroauricular Lymph
Nodes, Lymph Nodes for Head and Neck CS Site-Specific Factor 7 Upper and Lower
Cervical Node Levels CS Site-Specific Factor 8 Extracapsular
Extension Clinically, Lymph Nodes for Head
and Neck CS Site-Specific Factor 9 Extracapsular
Extension Pathologically, Lymph Nodes for
Head and Neck CS Site-Specific Factor 10 HPV (Human
Papilloma Virus) Status CS Site-Specific Factor 11 Measured Thickness
(Depth) CS Site-Specific Factor 12 CS Site-Specific Factor 13 CS Site-Specific Factor 14 CS Site-Specific Factor 15 CS Site-Specific Factor 16 CS Site-Specific Factor 17 CS Site-Specific Factor 18 CS Site-Specific Factor 19 CS Site-Specific Factor 20 CS Site-Specific Factor 21 CS Site-Specific Factor 22 CS Site-Specific Factor 23 CS Site-Specific Factor 24 CS Site-Specific Factor 25
The following tables are
available at the collaborative
staging website:
Histology Inclusion Table
AJCC 7th ed. Histology Exclusion Table
AJCC 6th ed. AJCC TNM 7 Stage AJCC TNM 6 Stage Summary Stage
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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Malignant Melanoma of Other Lip
CS Tumor Size (Revised: 02/03/2010)
Code Description
000 No mass/tumor found
001-988 001 - 988 millimeters (code exact size in millimeters)
989 989 millimeters or larger
990 Microscopic focus or foci only and no size of focus given
991 Described as "less than 1 cm"
992 Described as "less than 2 cm," or "greater than 1 cm," or "between 1 cm and 2 cm"
993 Described as "less than 3 cm," or "greater than 2 cm," or "between 2 cm and 3 cm"
994 Described as "less than 4 cm," or "greater than 3 cm," or "between 3 cm and 4 cm"
995 Described as "less than 5 cm," or "greater than 4 cm," or "between 4 cm and 5 cm"
999 Unknown; size not stated
Not documented in patient record
Malignant Melanoma of Other Lip
CS Extension (Revised: 01/04/2010) Note 1: AJCC does not include a Tis or TX category for melanoma of mucosa of head and neck sites. Extension codes of
000 and 999 will be mapped to NA and AJCC stage group will be derived as NA.
Note 2: AJCC does not include a T1 or T2 category for mucosal melanoma of head and neck sites.
Note 3: Use code 300 for localized tumor ONLY if no information is available to assign code 105 or 470.
Note 4: Use code 470, 775, 810, or 815 if the physician's assignment of T category is the ONLY information
available about the extent of the tumor.
Code Description TNM 7 TNM 6 SS77 SS2000
000 In situ; noninvasive; intraepithelial NA NA IS IS
100 OBSOLETE DATA RETAINED V0200
Invasive tumor confined to:
Labial mucosa (inner lip)
Lamina propria
Multiple foci
Submucosa (superficial invasion)
Vermilion surface
Superficial extension to:
Skin of lip
Subcutaneous soft tissue of lip
ERROR NA L L
105 Tumor confined to mucosa of lower lip:
Labial mucosa (inner lip)
Vermilion surface
T3 NA L L
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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Code Description TNM 7 TNM 6 SS77 SS2000
200 OBSOLETE DATA CONVERTED V0200
See code 520
Musculature
ERROR ERROR ERROR ERROR
300 Localized, NOS T3 NA L L
400 Extension via mucosa to:
Inner cheek (buccal mucosa)
Commissure (for lower lip)
Opposite (both) lip(s)
T3 NA RE RE
410 Extension via mucosa to:
Lower gingiva
Gingiva NOS
T3 NA RE RE
470 Stated as T3 with no other information on extension T3 NA L L
500 OBSOLETE DATA RETAINED V0200
Inner cheek (buccal mucosa)
Commissure
Opposite (both) lip(s)
ERROR NA RE RE
510 OBSOLETE DATA RETAINED V0200
Gingiva
ERROR NA RE RE
520 Involvement of deep soft tissue or musculature of lower
lip
Soft tissue NOS
T4a NA L L
530 520 + (400 or 410)
(Involvement of deep soft tissue or musculature of
lower lip + Mucosal involvement of any structure
in code 400 or 410)
T4a NA RE RE
540 Involvement of deep soft tissue or musculature of any
structure in code 400
T4a NA RE RE
550 Involvement of deep tissue or periosteum of lower
gingiva
T4a NA RE RE
748 Involvement of deep tissue or musculature of floor of
mouth or tongue
Inferior alveolar nerve
T4a NA D D
750 OBSOLETE DATA RETAINED V0200
Tongue
ERROR NA D D
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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Code Description TNM 7 TNM 6 SS77 SS2000
755 Extrinsic muscle of tongue
Genioglossus
Hyoglossus
Palatoglossus
Styloglossus
T4a NA D D
760 Skin of face/neck T4a NA D D
765 Cartilage NOS
Cortical bone NOS
Bone NOS excluding skull base
T4a NA D D
770 OBSOLETE DATA RETAINED V0200
Cortical bone (other than code 700)
Floor of mouth
Inferior alveolar nerve
ERROR NA D D
775 Stated as T4a with no other information on extension T4a NA L L
790 Contiguous extension:
Masticator space
Pterygoid plates
Skull base
Internal carotid artery (encased)
T4b NA D D
800 OBSOLETE DATA RETAINED V0200
Further contiguous extension
ERROR NA D D
801 Further contiguous extension including:
Brain
Dura
Lower cranial nerves (IX, X, XI, XII)
Prevertebral space
Mediastinal structures
T4b NA D D
810 Stated as T4b with no other information on extension T4b NA D D
815 Stated as T4 NOS with no other information on
extension
T4NOS NA L L
950 OBSOLETE DATA RETAINED V0200
No evidence of primary tumor
ERROR NA U U
999 Unknown extension
Primary tumor cannot be assessed
Not documented in patient record
NA NA U U
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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Malignant Melanoma of Other Lip
CS Tumor Size/Ext Eval (Revised: 11/13/2009)
Code Description Staging
Basis 7
Staging
Basis 6
0 Does not meet criteria for AJCC pathologic staging:
No surgical resection done. Evaluation based on physical examination,
imaging examination, or other non-invasive clinical evidence. No autopsy
evidence used.
c
1 Does not meet criteria for AJCC pathologic staging:
No surgical resection done. Evaluation based on endoscopic examination,
diagnostic biopsy, including fine needle aspiration biopsy, or other
invasive techniques, including surgical observation without biopsy. No
autopsy evidence used.
c
2 Meets criteria for AJCC pathologic staging:
No surgical resection done, but evidence derived from autopsy (tumor was
suspected or diagnosed prior to autopsy)
p
3 Either criteria meets AJCC pathologic staging:
Surgical resection performed WITHOUT pre-surgical systemic treatment or
radiation
OR surgical resection performed, unknown if pre-surgical systemic treatment or
radiation performed
AND Evaluation based on evidence acquired before treatment, supplemented or
modified by the additional evidence acquired during and from surgery,
particularly from pathologic examination of the resected specimen.
No surgical resection done. Evaluation based on positive biopsy of highest T
classification.
p
5 Does not meet criteria for AJCC y-pathologic (yp) staging:
Surgical resection performed AFTER neoadjuvant therapy and tumor
size/extension based on clinical evidence, unless the pathologic evidence at
surgery (AFTER neoadjuvant) is more extensive (see code 6).
c
6 Meets criteria for AJCC y-pathologic (yp) staging:
Surgical resection performed AFTER neoadjuvant therapy AND tumor
size/extension based on pathologic evidence, because pathologic evidence
at surgery is more extensive than clinical evidence before treatment.
yp
8 Meets criteria for autopsy (a) staging:
Evidence from autopsy only (tumor was unsuspected or undiagnosed prior to
autopsy)
a
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
The official version of this document is online at www.cancerstaging.org/cstage/manuals.
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Code Description Staging
Basis 7
Staging
Basis 6
9 Unknown if surgical resection done
Not assessed; cannot be assessed
Unknown if assessed
Not documented in patient record
c
Malignant Melanoma of Other Lip
CS Lymph Nodes (Revised: 12/26/2009) Note 1: For head and neck schemas, this field includes all lymph nodes defined as Levels I-VII and Other by
AJCC. The complete definitions are provided in the General Instructions.
Note 2: For head and neck schemas, additional information about lymph nodes (size of involved nodes,
extracapsular extension, levels involved, and location above or below the lower border of the criocid cartilage) is
coded in Site-Specific Factors 1, 3-9.
Note 3: For head and neck cancers, if lymph nodes are described only as "supraclavicular", try to determine if they
are in Level IV (deep to the sternocleidomastoid muscle, in the lower jugular chain) or Level V (in the posterior
triangle, inferior to the transverse cervical artery) and code appropriately. If the specific level cannot be determined,
consider them as Level V nodes.
Code Description TNM 7 TNM 6 SS77 SS2000
000 None; no regional lymph node involvement N0 NA NONE NONE
100 Positive regional node(s):
Level I node:
Level IA - Submental
Level IB - Submandibular (submaxillary),
sublingual
Other groups:
Facial:
Buccinator (buccal)
Mandibular
Nasolabial
Parotid:
Infraauricular
Intraparotid
Periparotid
Preauricular
Regional lymph node, NOS
N1 NA RN RN
110 Positive regional node(s):
Level II node - Upper jugular
Jugulodigastric (subdigastric)
Upper deep cervical
Level III node - Middle jugular
Middle deep cervical
Level IV node - Lower jugular
Jugulo-omohyoid (supraomohyoid)
Lower deep cervical
Virchow node
Cervical, NOS
Deep cervical, NOS
Internal jugular, NOS
N1 NA D RN
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29 April 2010 Part II - Lip - 122 Version 02.02.00
Code Description TNM 7 TNM 6 SS77 SS2000
120 Positive regional node(s):
Level V node - Posterior triangle group
Posterior cervical
Level VA - Spinal accessory
Level VB - Transverse cervical,
supraclavicular (see Note 3)
Level VI node - Anterior compartment group
Laterotracheal
Paralaryngeal
Paratracheal - above suprasternal notch
Perithyroidal
Precricoid ( Delphian)
Prelaryngeal
Pretracheal - above suprasternal notch
Recurrent laryngeal
Level VII node - Superior mediastinal group
(for other mediastinal nodes see CS Mets at
DX)
Esophageal groove
Paratracheal - below suprasternal notch
Pretracheal - below suprasternal notch
Other groups:
Parapharyngeal
Retroauricular
Retropharyngeal
Suboccipital
N1 NA D D
180 Stated as N1, no other information N1 NA RN RN
190 OBSOLETE DATA RETAINED V0200
Stated as N2a, no other information
ERROR NA RN RN
200 OBSOLETE DATA RETAINED V0200
Multiple positive ipsilateral nodes listed in code 100
ERROR NA RN RN
210 OBSOLETE DATA RETAINED V0200
Multiple positive ipsilateral nodes listed in code 110
ERROR NA D RN
220 OBSOLETE DATA RETAINED V0200
Multiple positive ipsilateral nodes, any listed in code
120
ERROR NA D D
290 OBSOLETE DATA RETAINED V0200
Stated as N2b, no other information
ERROR NA RN RN
300 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 100:
Positive ipsilateral node(s), not stated if single or
multiple
ERROR NA RN RN
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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Code Description TNM 7 TNM 6 SS77 SS2000
310 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 110
Positive ipsilateral node(s), not stated if single or
multiple
ERROR NA D RN
320 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 120:
Positive ipsilateral node(s), not stated if single or
multiple
ERROR NA D D
400 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 100:
Positive bilateral or contralateral nodes
ERROR NA RN RN
410 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 110
Positive bilateral or contralateral nodes
ERROR NA D RN
420 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 120:
Positive bilateral or contralateral nodes
ERROR NA D D
490 OBSOLETE DATA RETAINED V0200
Stated as N2c, no other information
ERROR NA RN RN
500 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 100:
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral,
AND not stated if single or multiple
ERROR NA RN RN
510 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 110
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral
AND not stated if single or multiple
ERROR NA D RN
520 OBSOLETE DATA RETAINED V0200
Regional lymph nodes as listed in code 120:
Positive node(s), not stated if ipsilateral, or bilateral, or
contralateral,
AND not stated if single or multiple
ERROR NA D D
600 OBSOLETE DATA RETAINED V0200
Stated as N2, NOS
ERROR NA RN RN
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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Code Description TNM 7 TNM 6 SS77 SS2000
700 OBSOLETE DATA RETAINED V0200
Stated as N3, no other information
ERROR NA RN RN
800 Lymph nodes, NOS, no other information N1 NA RN RN
999 Unknown; not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
NX NA U U
Malignant Melanoma of Other Lip
CS Lymph Nodes Eval (Revised: 11/13/2009) Note 1: This field is used primarily to derive the staging basis for the N category in the TNM system. It records
how the code for the item "CS Lymph Nodes" was determined based on the diagnostic methods employed and their
intent.
Note 2: In the 7th edition of the AJCC manual, the clinical and pathologic classification rules for the N category were
changed to reflect current medical practice. The N is designated as clinical or pathologic based on the intent
(workup versus treatment) matching with the assessment of the T classification. When the intent is workup, the
staging basis is clinical, and when the intent is treatment, the staging basis is pathologic.
A. Microscopic assessment including biopsy of regional nodes or sentinel nodes if being performed as part of
the workup to choose the treatment plan, is therefore part of the clinical staging. When it is part of the workup, the
T category is clinical, and there has not been a resection of the primary site adequate for pathologic T classification
(which would be part of the treatment).
B. Microscopic assessment of regional nodes if being performed as part of the treatment is therefore part of the
pathologic staging. When it is part of the treatment, the T category is pathologic, and there has been a resection of
the primary site adequate for pathologic T classification (all part of the treatment).
Note 3: Microscopic assessment of the highest N category is always pathologic (code 3).
Note 4: If lymph node dissection is not performed after neoadjuvant therapy, use code 0 or 1.
Note 5: Only codes 5 and 6 are used if the node assessment is performed after neoadjuvant therapy.
Code Description Staging
Basis 7
Staging
Basis 6
0 Does not meet criteria for AJCC pathologic staging:
No regional lymph nodes removed for examination. Evidence based on
physical examination, imaging examination, or other non-invasive clinical
evidence. No autopsy evidence used.
c
1 Does not meet criteria for AJCC pathologic staging based on at least one of the
following criteria:
No regional lymph nodes removed for examination. Evidence based on
endoscopic examination, or other invasive techniques including surgical
observation, without biopsy. No autopsy evidence used.
OR
Fine needle aspiration, incisional core needle biopsy, or excisional biopsy of
regional lymph nodes or sentinel nodes as part of the diagnostic workup,
WITHOUT removal of the primary site adequate for pathologic T
classification (treatment).
c
Collaborative Stage Data Collection System Coding Instructions PART II: Site-Specific Schemas
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29 April 2010 Part II - Lip - 125 Version 02.02.00
Code Description Staging
Basis 7
Staging
Basis 6
2 Meets criteria for AJCC pathologic staging:
No regional lymph nodes removed for examination, but evidence derived from
autopsy (tumor was suspected or diagnosed prior to autopsy).
p
3 Meets criteria for AJCC pathologic staging based on at least one of the
following criteria:
Any microscopic assessment of regional nodes (including FNA, incisional core
needle bx, excisional bx, sentinel node bx or node resection), WITH
removal of the primary site adequate for pathologic T classification
(treatment) or biopsy assessment of the highest T category.
OR
Any microscopic assessment of a regional node in the highest N category,
regardless of the T category information.
p
5 Does not meet criteria for AJCC y-pathologic (yp) staging:
Regional lymph nodes removed for examination AFTER neoadjuvant therapy
AND lymph node evaluation based on clinical evidence, unless the
pathologic evidence at surgery (AFTER neoadjuvant) is more extensive
(see code 6).
c
6 Meets criteria for AJCC y-pathologic (yp) staging:
Regional lymph nodes removed for examination AFTER neoadjuvant therapy
AND lymph node evaluation based on pathologic evidence, because the
pathologic evidence at surgery is more extensive than clinical evidence
before treatment.
yp
8 Meets criteria for AJCC autopsy (a) staging:
Evidence from autopsy; tumor was unsuspected or undiagnosed prior to
autopsy.
a
9 Unknown if lymph nodes removed for examination
Not assessed; cannot be assessed
Unknown if assessed
Not documented in patient record
c
Malignant Melanoma of Other Lip
Reg LN Pos (Revised: 03/30/2009) Note: Record this field even if there has been preoperative treatment.
Code Description
00 All nodes examined negative.
01-89 1 - 89 nodes positive (code exact number of nodes positive)
90 90 or more nodes positive
95 Positive aspiration or core biopsy of lymph node(s)
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Code Description
97 Positive nodes - number unspecified
98 No nodes examined
99 Unknown if nodes are positive; not applicable
Not documented in patient record
Malignant Melanoma of Other Lip
Reg LN Exam (Revised: 03/02/2009)
Code Description
00 No nodes examined
01-89 1 - 89 nodes examined (code exact number of regional lymph nodes examined)
90 90 or more nodes examined
95 No regional nodes removed, but aspiration or core biopsy of regional nodes performed
96 Regional lymph node removal documented as sampling and number of nodes unknown/not stated
97 Regional lymph node removal documented as dissection and number of nodes unknown/not stated
98 Regional lymph nodes surgically removed but number of lymph nodes unknown/not stated and not
documented as sampling or dissection; nodes examined, but number unknown
99 Unknown if nodes were examined; not applicable or negative
Not documented in patient record
Malignant Melanoma of Other Lip
CS Mets at DX (Revised: 11/07/2009) Note: Supraclavicular and transverse cervical lymph nodes are coded in CS Lymph Nodes because they are
categorized as N rather than M in AJCC TNM.
Code Description TNM 7 TNM 6 SS77 SS2000
00 No; none M0 NA NONE NONE
10 Distant lymph node(s)
Mediastinal
Distant lymph node(s), NOS
M1 NA D D
40 Distant metastases except distant lymph node(s)(code
10)
Carcinomatosis
M1 NA D D
50 10 + 40)
(Distant lymph node(s) + Other distant metastases)
M1 NA D D
60 Distant metastasis, NOS
Stated as M1, NOS
M1 NA D D
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Code Description TNM 7 TNM 6 SS77 SS2000
99 Unknown if distant metastasis
Distant metastasis cannot be assessed
Not documented in patient record
M0 NA U U
Malignant Melanoma of Other Lip
CS Mets Eval (Revised: 11/13/2009) Note: This item reflects the validity of the classification of the item CS Mets at DX only according to the
diagnostic methods employed.
Code Description Staging
Basis 7
Staging
Basis 6
0 Does not meet criteria for AJCC pathologic staging of distant metastasis:
Evaluation of distant metastasis based on physical examination, imaging
examination, and/or other non-invasive clinical evidence. No pathologic
examination of metastatic tissue performed or pathologic examination was
negative.
c
1 Does not meet criteria for AJCC pathologic staging of distant metastasis:
Evaluation of distant metastasis based on endoscopic examination or other
invasive technique, including surgical observation without biopsy. No
pathologic examination of metastatic tissue performed or pathologic
examination was negative.
c
2 Meets criteria for AJCC pathologic staging of distant metastasis:
No pathologic examination of metastatic specimen done prior to death, but
positive metastatic evidence derived from autopsy (tumor was suspected or
diagnosed prior to autopsy).
p
3 Meets criteria for AJCC pathologic staging of distant metastasis:
Specimen from metastatic site microscopically positive WITHOUT pre-surgical
systemic treatment or radiation
OR specimen from metastatic site microscopically positive, unknown if pre-
surgical systemic treatment or radiation performed
OR specimen from metastatic site microscopically positive prior to neoadjuvant
treatment.
p
5 Does not meet criteria for AJCC y-pathologic (yp) staging of distant metastasis:
Specimen from metastatic site microscopically positive WITH pre-surgical
systemic treatment or radiation, BUT metastasis based on clinical
evidence.
c
6 Meets criteria for AJCC y-pathologic (yp) staging of distant metastasis:
Specimen from metastatic site microscopically positive WITH pre-surgical
systemic treatment or radiation, BUT metastasis based on pathologic
evidence.
yp
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Code Description Staging
Basis 7
Staging
Basis 6
8 Meets criteria for AJCC autopsy (a) staging of distant metastasis:
Evidence from autopsy based on examination of positive metastatic tissue AND
tumor was unsuspected or undiagnosed prior to autopsy.
a
9 Not assessed; cannot be assessed
Unknown if assessed
Not documented in patient record
c
Malignant Melanoma of Other Lip
CS Site-Specific Factor 1 Size of Lymph Nodes (Revised: 12/01/2009) Note: Code the largest diameter, whether measured clinically or pathologically, of any involved regional lymph
node(s). Do not code the size of any nodes coded in CS Mets at DX.
Code Description
000 No involved regional nodes
001-979 001-979 millimeters (code exact size in millimeters)
980 980 millimeters or larger
981-988 OBSOLETE DATA CONVERTED V0200
See code 980
981-988 millimeters
989 OBSOLETE DATA CONVERTED V0200
See code 980
989 millimeters or larger
990 Microscopic focus or foci only, no size of focus given
991 Described as "less than 1cm"
992 Described as "less than 2cm" or "greater than 1cm" or "between 1cm and 2cm"
993 Described as "less than 3cm" or "greater than 2cm" or "between 2cm and 3cm"
994 Described as "less than 4cm" or "greater than 3cm" or "between 3cm and 4cm"
995 Described as "less than 5cm" or "greater than 4cm" or "between 4cm and 5cm"
996 Described as "less than 6cm" or "greater than 5cm" or "between 5cm and 6cm"
997 Described as "more than 6cm"
999 Regional lymph node(s) involved, size not stated
Unknown if regional lymph node(s) involved
Not documented in patient record
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CS Site-Specific Factor 2 OBSOLETE - Extracapsular Extension, Lymph Nodes for Head
and Neck (Revised: 12/30/2009) Note 1: This CS Site-Specific Factor is obsolete beginning with CS Version 2 (codes and notes). Old data are
retained, but new cases are not coded with this Factor. Use code 988 for this field.
Note 2: Code the status of extracapsular extension whether assessed clinically or pathologically of any involved
regional lymph node(s) coded in the CS Lymph Nodes field. Do not code extracapsular extension in any nodes
coded in CS Mets at DX in this field.
Note 3: A statement of the presence or absence of extracasular extension in a pathology report takes priority over
clinical assessment. However, if the pathology report contains no statement about extracapsular extension, either
positive or negative, the clinical assessment should be coded. If nodes are involved but there is neither a clinical
assessment of extranodal extension nor a statement about it in the pathology report, use code 999.
Note 4: According to AJCC (page 24), "Imaging studies showing amorphous speculated margins of involved nodes
or involvement of internodal fat resulting in loss of normal oval-to-round nodal shape strongly suggest extracapsular
(extranodal) tumor spread; however, pathologic examination is necessary for documentation of the extent of such
disease."
Note 5: CS Site-Specific Factor 2 is obsolete beginning with CS Version 2 (codes and notes). Old data are retained,
but new cases are not coded with this Factor. Use code 988 for this field.
Code Description
000 OBSOLETE DATA RETAINED V0200
No extracapsular extension
001 OBSOLETE DATA RETAINED V0200
Extracapsular extension clinically, not assessed pathologically
Nodes described as "fixed", not assessed pathologically
005 OBSOLETE DATA RETAINED V0200
Extracapsular extension present pathologically
888 OBSOLETE DATA CONVERTED V0200
See code 987
Not applicable; no lymph node involvement
987 OBSOLETE DATA CONVERTED AND RETAINED V0200
Data converted from code 888
Not applicable; no lymph node involvement
988 Not applicable:
Information not collected for this case
999 OBSOLETE DATA RETAINED V0200
Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
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CS Site-Specific Factor 3 Levels I-III, Lymph Nodes for Head and Neck (Revised: 03/30/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Code Description
000 No lymph node involvement in Levels I, II, or III
100 Level I lymph node(s) involved
010 Level II lymph node(s) involved
001 Level III lymph node(s) involved
110 Level I and II lymph nodes involved
101 Level I and III lymph nodes involved
011 Level II and III lymph nodes involved
111 Level I, II and III lymph nodes involved
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Malignant Melanoma of Other Lip
CS Site-Specific Factor 4 Levels IV-V and Retropharyngeal Lymph Nodes for Head and
Neck (Revised: 03/30/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Code Description
000 No lymph node involvement in Levels IV or V or retropharyngeal
100 Level IV lymph node(s) involved
010 Level V lymph node(s) involved
001 Retropharyngeal nodes involved
110 Level IV and V lymph nodes involved
101 Level IV and retropharyngeal nodes involved
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Code Description
011 Level V and retropharyngeal nodes involved
111 Level IV and V and retropharyngeal lymph nodes involved
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
Malignant Melanoma of Other Lip
CS Site-Specific Factor 5 Levels VI-VII and Facial Lymph Nodes for Head and Neck (Revised:
03/30/2009) Note 1: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Note 2: Facial nodes including buccinator, mandibular, and nasolabial lymph nodes.
Code Description
000 No lymph node involvement in Levels VI or VII or facial nodes
100 Level VI lymph node(s) involved
010 Level VII lymph node(s) involved
001 Facial lymph node(s) involved
110 Level VI and VII lymph nodes involved
101 Level VI and facial nodes involved
011 Level VII and facial nodes involved
111 Level VI and VII and facial lymph nodes involved
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
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Malignant Melanoma of Other Lip
CS Site-Specific Factor 6 Parapharyngeal, Parotid, and Suboccipital/Retroauricular
Lymph Nodes, Lymph Nodes for Head and Neck (Revised: 08/25/2009) Note: Site-Specific Factors 3-6 are used to code the presence or absence of lymph node involvement in each of 7
different levels and other groups defined by AJCC. The definitions of the levels are the same for all applicable head
and neck sites. One digit is used to represent lymph nodes of a single level, with the three digits of Site-Specific
Factor 3 representing lymph nodes of, respectively, Levels I-III; the digits of Site-Specific Factor 4 representing
lymph nodes of Levels IV and V and the retropharyngeal nodes; the digits of Site-Specific Factor 5 representing
lymph nodes of Levels VI and VII and the facial nodes; and the digits of Site-Specific Factor 6 representing the
remaining Other groups as defined by AJCC. In each digit, a code 1 means Yes, the nodes are involved.
Code Description
000 No involvement of any group:
Parapharyngeal lymph nodes
Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes
Suboccipital/retroauricular lymph nodes
100 Parapharyngeal lymph node(s) involved
010 Parotid (preauricular, periparotid, and/or intraparotid) lymph node(s) involved
001 Suboccipital/retroauricular lymph node(s) involved
110 Involvement of two groups:
Parapharyngeal lymph nodes
Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes
101 Involvement of two groups:
Parapharyngeal lymph nodes
Suboccipital/retroauricular lymph nodes
011 Involvement of two groups:
Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes
Suboccipital lymph nodes
111 Involvement of three groups:
Parapharyngeal lymph nodes
Parotid (preauricular, periparotid, and/or intraparotid) lymph nodes
, Suboccipital/retroauricular lymph nodes
999 Unknown if regional lymph node(s) involved, not stated
Regional lymph nodes cannot be assessed
Not documented in patient record
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CS Site-Specific Factor 7 Upper and Lower Cervical Node Levels (Revised: 03/30/2009) Note 1: AJCC requires that nodes be designated as involving upper or lower levels within the neck. The boundary
between upper and lower levels is the lower border of the cricoid cartilage.
Note 2: Nodes in Levels I, II, and III are upper level nodes. Nodes in Level IV and VII are lower level nodes.
Level VA nodes are upper level nodes, and Level VB are lower level nodes. Level VI nodes span both upper and
lower levels. Nodes included in "Other groups" (Facial, Parotid, Parapharyngeal, Retropharyngeal, Retroauricular,
and Suboccipital) are all upper level nodes.
Note 3: Code the location of nodal involvement in relation to the lower border of the cricoid cartilage of all
involved nodes, whether assessed clinically or pathologically, as stated by a physician.
Note 4: If there is no physician statement of upper and/or lower level nodal involvement, assign levels I, II, III, and
VA nodes to upper level. Assign level IV, VB, and VII to lower level. If Level V (A and B not specified) and/or
Level VI nodes are involved with no further information about location, use code 040.
Note 5: A description of "mid neck" requires clarification with the physician. Code 040, unknown level, if "mid
neck" is the only information available.
Code Description
000 No lymph nodes involved
010 Upper level lymph nodes involved (all involved nodes above the lower border of the cricoid cartilage)
020 Lower level lymph nodes involved (all involved nodes below the lower border of the cricoid cartilage)
030 Upper and lower level lymph nodes involved (all involved nodes both above and below the lower
border of the cricoid cartilage)
040 Unknown level lymph nodes involved (unable to determine if involved nodes above or below the lower
border of the cricoid cartilage)
988 Not applicable:
Information not collected for this case
999 Unknown if regional lymph node(s) involved, not stated Not documented in patient record
Malignant Melanoma of Other Lip
CS Site-Specific Factor 8 Extracapsular Extension Clinically, Lymph Nodes for Head and
Neck (Revised: 10/16/2009) Note 1: Code the status of extracapsular extension accessed clinically for any involved regional lymph node(s)
coded in the CS Lymph Nodes field. Do not code extracapsular extensio in any nodes coded in CS Mets at DX in
this field.
Note 2: If nodes are involved clinically, and documentation of physical examination or imaging is available
without a statement of extracapsular extension, use code 010.
Note 3: If the only documentation is a reference to clinically involved nodes with no reference to extracapsular
extension, use code 030.
Note 4: If there is no information about clinical assessment of nodes, use code 999.
Note 5: Clinical assessment can be by physical examination or imaging. According to AJCC, "ECS can be
diagnosed clinically by a matted mass of nodes adherent to overlying skin, adjacent soft tissue, or clinical evidence
of cranial nerve tissue. Radiologic signs of ECS include amorphous, spiculated margins of a metastatic node and
stranding of the perinodal soft tissue in previously untreated patients."
Code Description
000 No lymph nodes involved clinically
010 Nodes involved clinically, no extracapsular extension clinically
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Code Description
020 Nodes involved clinically, extracapsular extension clinically (nodes described as fixed or matted)
030 Nodes involved clinically, unknown if extracapsular extension
988 Not applicable:
Information not collected for this case
997 Clinical examination of lymph nodes performed, unknown results
998 No clinical examination of lymph nodes
999 Unknown if regional lymph node(s) involved clinically, not stated Regional lymph nodes cannot be
accessed Not documented in patient record
Malignant Melanoma of Other Lip
CS Site-Specific Factor 9 Extracapsular Extension Pathologically, Lymph Nodes for Head
and Neck (Revised: 08/25/2009) Note 1: Code the status of extracapsular extension assessed pathologically of any involved regional lymph node(s)
coded in the CS Lymph Nodes field. Do not code extracapsular extension in any nodes coded in CS Mets at DX in
this field.
Note 2: If nodes are involved pathologically but there is no statement of extranodal extension in the pathology
report, use code 010.
Note 3: Code "microscopic" or "macroscropic" extranodal extension as stated in the final diagnosis. If not stated in
the final diagnosis, code "microscopic" if extranodal extension is described only in the microscopic section of the
pathology report and "macroscopic" if extranodal extension is described in the gross section of the pathology report.
Note 4: "Macroscopic" extension takes priority over "microscopic" extension.
Note 5: Use code 040 if pathologic extracapsular extension is described with no further information and the
pathology report is not available for review.
Note 6: Use code 050 if nodes involved pathologically with no further information about extracapsular extension.
Code Description
000 No lymph nodes involved pathologically
010 Nodes involved pathologically, no extracapsular extension pathologically
020 Nodes involved pathologically, MICROSCOPIC extracapsular extension pathologically
030 Nodes involved pathologically, MACROSCOPIC extracapsular extension pathologically
040 Nodes involved pathologically, extracapsular extension pathologically, unknown if microscopic or
macroscopic
050 Nodes involved pathologically, unknown if extracapsular extension
988 Not applicable:
Information not collected for this case
997 Pathologic examination of lymph nodes performed, results not available
998 No pathologic examination of lymph nodes
999 Unknown if regional lymph node(s) involved pathologically, not stated
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CS Site-Specific Factor 10 HPV (Human Papilloma Virus) Status (Revised: 10/12/2009) Note 1: There is evidence that human papilloma virus (HPV) plays a role in the pathogenesis of some cancers.
Note 2: Record the results of any HPV testing performed on pathologic specimens from the primary tumor or a
metastatic site, including regional nodes. HPV testing may be performed for prognostic purposes; testing may also
be performed on metastatic sites to aid in the determination of the primary site.
Note 3: The highest risk HPV types are types 16 and 18. Other high risk types are 31, 33, 35, 36, 45, 51, 52, 56, 58,
59, 68, 26, 53, 66, 67, 69, 70, 73, 82, 85 Low risk types are 6, 11, 32, 34, 40, 42, 44, 54, 61, 62, 64, 71, 72, 74, 81,
83, 84, 87, 89. The HPV vaccine is designed to protect against types 16 and 18 (associated with cervical cancer) and
types 6 and 11 (associated with genital warts).
Note 4: High risk may be abbreviated "hrHPV" or "HR-HPV".
Note 5: Some tests for HPV, such as a hybrid capture test, only report negative or positive for high risk HPV
without identifying types; use codes 025 and 050, respectively to report those test results.
Code Description
000 HPV test negative; not positive for any HPV types
Negative, NOS
010 LOW RISK positive (all positive type(s) are low risk)
020 HIGH RISK positive, specified type(s) other than types 16 or 18,
WITH or WITHOUT positive results for low risk type(s)
030 HIGH RISK positive for HPV 16 WITHOUT positive results for HPV 18 or positivity of HPV 18
unknown,
WITH or WITHOUT positive results for other high-risk types,
WITH or WITHOUT positive results for low risk type(s)
040 HIGH RISK positive for HPV 18 WITHOUT positive results for HPV 16 or positivity of HPV 16
unknown,
WITH or WITHOUT positive results for other high-risk types,
WITH or WITHOUT positive results for low risk type(s)
050 HIGH RISK positive for HPV 16 AND HPV 18,
WITH or WITHOUT positive results for other high-risk types,
WITH or WITHOUT positive results for low risk type(s)
060 HIGH RISK positive, NOS, type(s) not specified
070 Positive, NOS, risk and type(s) not stated
988 Not applicable:
Information not collected for this case
997 Test ordered, results not in chart
998 Test not done (test was not ordered and was not performed), including no pathologic specimen
available for HPV testing
999 Unknown or no information
Not documented in patient record
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CS Site-Specific Factor 11 Measured Thickness (Depth) (Revised: 11/15/2009) Note 1: Code MEASURED THICKNESS (Depth) of the invasive tumor not size, diameter, or any other
measurement. Record the actual measurement in tenths of millimeters as stated on the pathology repot. Do not
record the measurement from a radiographic report.
Note 2: Record the measurement labeled specifically as thickness or depth of tumor. In the absence of a label,use
the "cut surface" dimension, or the third dimension from a description of 3 dimensions (N1 x N2 x N3). For
example, from a tumor size recorded as 2cm x 1cm x 0.5cm, record 050.
Code Description
000 No mass/tumor found
001-979 Exact thickness in tenths of millimeters
Examples:
001 0.1 millimeter
010 1 millimeter
042 4.2 millimeters
100 10 millimeters, 1 centimeter
103 10.3 millimeters
980 98.0 millimeters or larger
987 Not applicable, in situ carcinoma
988 Not applicable:
Information not collected for this case
990 Microinvasion
Microscopic focus or foci only; no depth given
998 No surgical specimen
999 Not documented in patient record
Unknown, thickness not stated
Malignant Melanoma of Other Lip
CS Site-Specific Factor 12 (Revised: 06/30/2008)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Other Lip
CS Site-Specific Factor 13 (Revised: 06/30/2008)
Code Description
988 Not applicable for this schema
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CS Site-Specific Factor 14 (Revised: 06/30/2008)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Other Lip
CS Site-Specific Factor 15 (Revised: 06/30/2008)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Other Lip
CS Site-Specific Factor 16 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Other Lip
CS Site-Specific Factor 17 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Other Lip
CS Site-Specific Factor 18 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Other Lip
CS Site-Specific Factor 19 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Other Lip
CS Site-Specific Factor 20 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
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CS Site-Specific Factor 21 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Other Lip
CS Site-Specific Factor 22 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Other Lip
CS Site-Specific Factor 23 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Other Lip
CS Site-Specific Factor 24 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema
Malignant Melanoma of Other Lip
CS Site-Specific Factor 25 (Revised: 02/23/2009)
Code Description
988 Not applicable for this schema