Fujimoto M, et al. - Researchers retrospectively reviewed hematoxylin and eosin–stained sections of surgically resected cutaneous squamous cell carcinoma (CSCC) <4 cm in diameter, to assess the prognostic significance of tumor budding in CSCC. They defined tumor bud as an isolated cancer cell or a cluster comprising<5 cells. Tumor bud was counted at a hot spot (1.23 mm²), and graded between 1 and 3; grade 1: 0 to 4 buds; grade 2: 5 to 9 buds; and grade 3: ≥10 buds. They regarded cases with grades 2 or 3 as positive for tumor budding. 83.3% of metastasizing CSCC, and 37.5% of nonmetastasizing CSCC showed positive tumor budding. Moreover, worse disease-specific survival was observed for CSCCs with grade 3 tumor budding. These findings suggest the possible value of tumor budding as a histologic marker for risk stratification of early CSCC in routine practice. Evaluation and close follow-up for regional node metastasis seem to be beneficial in patients with tumor budding positive CSCC.