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Stage IV includes: IVA (T4a, N0, M0); (T4a, N1, M0); (T1, N2, M0); (T2, N2, M0); (T3, N2, M0); (T4a, N2, M0); IVB (Any T, N3, M0); (T4b, Any N, M0); IVC (Any T, Any N, M1). T4a (lip): Tumor invades through cortical bone or involves the inferior alveolar nerve, floor of mouth, or skin of face (i.e., chin or nose). T4a (oral cavity): Tumor invades adjacent structures only (e.g., through cortical bone of the mandible or maxilla, or involves the maxillary sinus or skin of face). Note: Superficial erosion of bone/tooth socket (alone) by a gingival primary is not sufficient to classify a tumor as T4. T1: Tumor size 2 cm or less in greatest dimension and 5 mm or less DOI. T2: Tumor size 2 cm or less in greatest dimension, DOI greater than 5 mm and equal or less than 10 mm or tumor greater than 2 cm but 4 cm or less in greatest dimension and 10 mm or less DOI. T3: Tumor size greater than 4 cm or any tumor greater than 10 mm DOI. T4b: Tumor invades masticator space, pterygoid plates, or skull base and/or encases the internal carotid artery. N0: No regional lymph node metastasis. N1: Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE(-). N2: Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE(+); or larger than 3 cm but not larger than 6 cm in greatest dimension and ENE (-); or metastases in multiple ipsilateral lymph nodes, none larger than 6 cm in greatest dimension and ENE(-); or metastases in bilateral or contralateral lymph nodes, none larger than 6 cm in greatest dimension, ENE(-). N3: Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE (-); or in a single ipsilateral lymph node larger than 3 cm in greatest dimension and ENE(+); or metastases in multiple ipsilateral, contralateral or bilateral lymph nodes any with ENE(+). M0: No distant metastasis. M1: Distant metastasis. (AJCC 8th Ed.)
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