While the overall prognosis of cutaneous squamous cell carcinoma (CSCC) is excellent, a subset of tumors do recur, metastasize, and cause death. Tumor characteristics associated with poor outcomes have been reported in a few case series. In this retrospective cohort study, Jambusaria-Pahlajani et al demonstrate that the bulk of poor outcomes occurred in AJCC stage T2 cases. Four risk factors were found to be statistically independent prognostic factors: poor differentiation, perineural invasion, tumor diameter greater than 2 cm, and invasion beyond subcutaneous fat. These factors were incorporated into an alternative staging system that may offer improved prognostic discrimination among stage T2 tumors.