Purpose of review: A validated and universal staging system for metastatic cutaneous head and neck squamous cell carcinoma that accurately describes its clinical behaviour is vital for prognostication and management. The current clinical staging system is not specific for the head and neck and makes no allowances for disease extent. The lack of an improved staging system prevents any meaningful research into improved treatment strategies in patients with head and neck cutaneous squamous cell carcinoma.
Recent findings: Contemporary evidence supports surgery and adjuvant radiotherapy as current best practice for patients with operable metastatic head and neck cutaneous squamous cell carcinoma. Despite this, patients with poor-prognosis disease are still at risk of locoregional relapse and may benefit from collaborative research. The modified staging system proposed by O'Brien is an important aspect of any further research and is discussed in this article.
Summary: The present clinical staging for head and neck cutaneous squamous cell carcinoma is inadequate and the evidence to date supports a recommendation for changing the current system to reflect the heterogeneity and complexity of this disease.