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Procedure

Tumor Site

Tumor Laterality (select all that apply)

Tumor Focality

Tumor Size/ Thickness (cm)

Tumor Depth of Invasion (mm)

Histologic Type

Histologic Grade (required for squamous cell carcinoma only)

+ Tumor Extension
Specify any other structures involved
Margins - Invasive tumor

Margins - In-situ tumor

Separately Submitted Tumor Bed Margin Orientation

Lymphovascular Invasion

Perineural Invasion

Pathologic Staging (pTNM)
TNM Descriptors (select all that apply)
pT
pN
pM

+ Additional Pathologic Findings (select all that apply)