[Angiosarcoma of the oral cavity. A clinical case report and review of the literature]

The authors describe a case of lip angiosarcoma. Angiosarcoma occurs rarely in the oral cavity, and in a recent review of the literature only 14 cases of such a localisation were found. Angiosarcomas are tumors with a very malignant biologic behavior and the 5-year survival is very low.

[Carcinoma of the lip: a retrospective study of 86 cases]

Carcinoma of the lip is a common lesion which is not always acknowledged as as a potentially lethal disease. The risk of cancer occurs most commonly among aging white men. The risk factors normally associated with lip cancer are rural residence and outdoor occupation. In addition, both actinic radiation and tobacco smoking have been considered casually related to lip cancer. The present study is based on a retrospective review of 86 patients (82 males, 4 females, mean age 65) affected by carcinoma of the lip, treated in Florence from 1970 to 1988. The most frequent site for carcinoma of the lip proved to be the lower lip (71 cases); other sites included the upper lip (7) and the commissure (8). The lip tumor was a squamous cell carcinoma in 82 patients and a basal cell carcinoma in the remaining four. Good prognosis was found for all those with relatively small lesions (T1-T2). On the contrary, the prognosis proved quite poor for those who exhibited tumor fixation to the mandible or erosion of the mandible (23.5%, 5 year survival). Primary radiotherapy may be used for the smaller lesions as cure rates proved equivalent to those achieved surgically although the authors found surgery is always preferable as a primary method of treatment. Surgical excision of the tumor is a relatively minor procedure with a minimum of morbidity as compared with radiation therapy which may lead to local tissue reaction and may disturb function. Surgical management is also recommended as it bears the advantage of being to give a histologically accurate tumor margin assessment. Moreover, with surgery, functional results are good.(ABSTRACT TRUNCATED AT 250 WORDS)

[The late treatment results in cancer of the lower lip]

Analysis of late results of treatment of carcinoma of the lower lip in 106 patients followed up for 4-5 years has confirmed that these results are worse if a patient consults a doctor late and if the process is disseminated. Our data evidence that late results do not depend on the method used to manage the primary focus on the lip, though radiotherapy may be considered as the optimal treatment modality. Histologic study of operation material after preventive surgery has not revealed metastases to regional lymph nodes, therefore if the lymph nodes are clinically intact, a dynamic follow-up is recommended after the primary focus is cured.

[The surgical treatment of carcinoma of the lip. A report on cases]

The authors study a group of 108 patients treated for lip carcinoma by surgery alone or associated with radiotherapy and/or chemotherapy. They point out that the stage at the moment of the first treatment influences the prognosis and they confirm the survival after surgical therapy around 60% at 5 years.

[Critical evaluation of the treatment-dependent prognosis index TPI based on the "prospective DOSAK study on squamous cell carcinomas of the lips, oral cavity and oropharynx"]

The "Treatment Dependent Prognostic Index" (TPI), which has been published by the authors in 1982 as a result of a retrospective observational study of the DOSAK (German-Austrian-Swiss Association for Head and Neck Tumors), is submitted to a critical review. For this purpose a sample of 1485 patients representing the "Prospective DOSAK-Study on Squamous Cell Carcinomas of the Lips, the Oral Cavity and the Oropharynx" were classified according to TPI. 13 TPI groups exhibited greater than or equal to 20 patients and were suitable for calculation of observed survival and comparison to their TPI prognoses. In 10 of 13 TPI groups observed and predicted survival are almost identical. 3 TPI groups show a considerable lack of correspondence between observation and prognosis. In general, the analyses revealed a high prognostic validity of TPI in its substantial parts. A further improvement of TPI by taking several tumor sites into consideration seems possible and will be a subject of future investigations.

[Malignant neoplasms of the lip, mouth, pharynx, nose, ear and larynx. A descriptive-epidemiologic study]

Between 1952 and 1986 the mortality from malignant tumours of the head and neck in the German Federal Republic shows a varying picture: a decline of cancer of the lip, equivocal rates for cancer of the nose and ear, increases for cancer of the tongue and of the larynx, a marked increase for cancer of the floor of the mouth and of the hypopharynx, a lesser increase for cancer of the tonsillar area and other parts of the mouth, but almost no increase for cancer of the salivary glands. The trends are similar for males and females, but the male:female ratio increased during the observation period. The increase of mortality begins in the middle age group. Based on the data of the cancer registry of the Saarland it can be estimated that on average the incidence is twice as high as mortality. In general the trend is similar both in incidence and mortality (but not the degree of the trend). Multiple malignancies of the head and neck are observed more often than expected and patients should be followed up carefully. Combined clinical-epidemiological studies are needed.

The step technique for the reconstruction of lower lip defects after cancer resection. A follow-up study of 165 cases

One hundred and sixty-five patients with localized cancer of the lower lip were excised and reconstructed over a 25-year period using Bengt Johanson's step technique. Eight-eight percent of the tumors were less than 2 cm in size and 65% were of high histopathological differentiation. Fifty-six percent were reconstructed with bilateral step flaps. Nine local recurrences appeared in 5 patients, none of whom died of lip cancer. Eight patients later developed regional metastases and 3 of these patients died of lip cancer. The 5-year survival rate was 98%. The step technique is recommended for reconstruction of lip defects of up to 2/3 of the lower lip and may, in larger resections, be combined with either a fan flap or an Estlander flap. The outstanding functional results are due to the use of adjacent tissue for the reconstruction which preserves the normal arrangement of muscles, vessels and nerves.

Oral cancer detection. The importance of routine screening for prolongation of survival

The incidence of oral cancer has increased in the past ten years. Early diagnosis and treatment are essential to long-term survival; however, patients at highest risk visit the dentist infrequently. The reddish, velvety or erythroplakial lesion at the base of the tongue or floor of the mouth is highly suspicious in any patient and requires further evaluation. High-risk patients with less suspicious appearing lesions must be reevaluated on close recall. Prognosis improves vastly when the lesion is detected and treated early. One study demonstrated a 64% five-year survival rate for patients with oral cancer that was diagnosed before regional lymph node involvement versus a 15% five-year survival for patients whose lesions were diagnosed after regional lymph node involvement. By including an oral cancer examination in routine physical examination of patients, the physician and public health nurse can increase the likelihood of early detection of oral cancer.

Carcinoma of the oral cavity and oropharynx

A high index of suspicion in smokers, coupled with inspection and palpation, is necessary for early diagnosis of cancer of the oral cavity and the oropharynx. Surgery or radiotherapy, or a combination of those modalities, is usually successful, except in advanced cases of cancer of the tongue base and the oropharynx.

[Choice of the treatment for lip carcinoma--an analysis on 74 cases]

This paper reports the results of the treatment of 74 patients with lip carcinoma from 1958-1974. All patients were proved by pathology and received their first course of treatment in our hospital. 44 of these patients were treated by radiation and 30, by surgery. The over-all five-year survival rate is 59% (44/74). Satisfactory results were obtained in the early lesions (stages I, II) either by surgery or radiation and the five-year survival rates are 66% (surgery 6/9, radiation 4/6). For stages III and IV, the result of operation is better than radiation's. The five-year survival rate in the former is 71% (15/21) and in the latter is 50% (19/38). In the stage IV lesions (T4), surgery was contraindicated but radiation was still able to cure 25% (1/4) of the patients. The optimal dose for the primary lesion was 6000-8000 rad/6-8 wk. For patients without any metastasis in the neck lymph nodes or with suspicious ones (N0, N1a, N2a), 12% (4/33) developed cervical metastasis if the upper neck area was left untreated. Yet none of them developed metastasis if the neck was treated prophylactically either by radiation (3000-4000 rad/3-4 wk) or by surgery. For patients with positive neck lymph nodes (N1b, N2b, N3), surgery was better than radiation (4000-6000 rad/4-6 wk).

Cancer and aplastic anemia in British Columbia farmers

For evaluation of occupational mortality in agriculture, age-standardized proportional mortality ratios (PMR) were calculated for 28,032 male farmers with the use of British Columbia (B.C.) death registrations collected from 1950 to 1978. Farmers had significantly elevated risks of death from cancer of the lip (PMR = 191, P = .05), stomach (PMR = 119, P less than .0001), and prostate gland (PMR = 113, P less than .001). In addition, leukemia was higher than expected (PMR = 122, P less than .01), as was aplastic anemia (PMR = 174, P less than .01). The elevated risks were fairly consistent over the 29-year period for stomach, prostate gland, and lip cancer, as well as for leukemia. The PMR for aplastic anemia was highest for the years 1950-59 and declined over the next 19 years. Farmers also showed significant mortality deficits for several important cancer sites, including esophagus (PMR = 59, P less than .0001), colon (PMR = 84, P less than .001), larynx (PMR = 62, P less than .01), and lung (PMR = 66, P less than .0001) for the period 1950-78. More detailed studies in B.C. will be necessary to confirm and extend these cancer-agriculture associations.

Cancer of the skin in blacks. II. A review of thirty-six black patients with squamous cell carcinoma of the lip

Cancer of the lip in blacks is rare, according to the literature. Using information obtained from the Tumor Registry of Charity Hospital of Louisiana in New Orleans, we discuss data on thirty-six black patients having a total of thirty-seven squamous cell carcinomas of the lip during the years 1948 to 1979. The overall mortality was 19.4% with metastasis developing from lower lip lesions in seven cases.

Malignant melanoma of the oral cavity

Primary malignant melanoma of the oral cavity is uncommon. Four cases are presented. The average age is in the sixth decade. Early diagnosis is difficult and prognosis is generally poor. Efforts toward earlier detection and treatment are recommended.

Carcinoma of the lip

Carcinoma of the lip is a common variety of head and neck malignancy frequently seen in the elderly Caucasian male. Three hundred and fifty consecutive cases of invasive squamous cell carcinoma of the lip are anlayzed and the treatment methods and their results are presented. Surgical management is recommended for most patients because of the advantage of tumor margin assessment, avoidance of radiotherapy complications, and rapid rehabilitation.

Carcinoma of the lip

(1) Carcinoma of the lip occurs predominantly in men in their seventh and eighth decades of life. (2) Epidermoid carcinoma is the most common malignant lip tumor. (3) Metastases to cervical lymph nodes are uncommon. (4) Elective neck dissection is not indicated. (5) Therapeutic radical neck dissection can benefit the patient in the presence of proved suprahyoid lymph node metastases. (6) The five year survival rate for epidermoid carcinoma of the lip is higher than the rate for epidermoid carcinoma of other sites in the oral cavity or pharynx. (7) Local recurrence does not correlate with the size of the primary tumor. (8) Initial treatment failures can frequently be salvaged surgically.

Advanced and recurrent squamous carcinoma of the lower lip

The results of aggressive surgical treatment of primary lip cancer and advanced and recurrent carcinoma of the lip are illustrated and discussed. Early detection of involved lymph nodes before capsular penetration occurs and careful and complete dissection of the submental and submandibular regions are advocated as possible ways to prevent persistent upper neck disease, the main killer of these patients.

Analysis of mortality and morbidity in 100 composite resections for oral carcinoma

The postoperative morbidity and mortality in one hundred patients who underwent composite resection for oral malignant disease are reviewed. Although there was a 7 per cent mortality and significant morbidity, the majority of patients did well. This procedure offers potential cure for life-threatening malignant disease.

Rhabdomyosarcoma in childhood

Fifty-four rhabdomyosarcomas in children affected mainly the pelvis and scrotum, 22 cases, head and neck, 19, and limbs and limb girdles, 11. Rhabdomyosarcomas of the female genital tract occurred only in children under 2 years, and those in the lower eyelid presented in the first year of life. A leiomyosarcoma-like appearance, and an undifferentiated small cell sarcoma sometimes mimicking Ewing's tumour, were patterns giving rise to diagnostic difficulty. Many fine gradations from undifferentiated embryonal to almost purely differentiated "pleomorphic" examples, made microscopic classification arbitrary. However, the histological pattern had no bearing on prognosis in children in this series. Of the 46 cases adequately followed, 43 are dead. Two of the 3 long-term survivors had paratesticular tumours.