Impact of cervical lymph node metastases from squamous cell cancer of the lip

Management of and risk factors for regional recurrence in upper lip squamous cell carcinoma

Our goal was to evaluate the risk factors for regional recurrence in upper lip squamous cell carcinoma (SCC).A total of 109 patients with upper lip SCC were retrospectively enrolled. Clinical and pathologic information was collected and analyzed.Fifteen (13.8%) patients had a regional metastasis, 2 patients had parotid node metastasis, and no local or distant metastasis was noted. There was neck level I node metastasis in 15 (100%) patients. In multivariate analysis, invasion depth and degree of differentiation were significantly associated with regional metastasis. The 5- and 10-year disease-specific survival rate was 95.4% and 80.1%, respectively.Invasion depth and degree of differentiation have reliable value for predicting regional metastasis.

Total lower lip and chin reconstruction with radial forearm free flap: A novel approach

BACKGROUND

The management of large chin and lower lip defects is challenging due to this facial subunit's tremendous functional and aesthetic importance. Specific methods for total lower lip and mentum reconstruction are not well chronicled. Aesthetic and functional goals of this reconstruction include restoration of oral competence by maintaining lower lip height, vermilion reestablishment, color-matched skin introduction to the chin, sensation restoration, and ideally restoration of dynamic activity to the lower lip.

METHODS

Literature review performed.

RESULTS

Presentation of novel, two-stage technique for lower lip and chin reconstruction with a submental flap and a radial forearm free flap, suspension of the lower lip and chin with a tensor fascia lata graft, and vermilion reconstruction with a buccal mucosal flap.

CONCLUSIONS

This procedure meets all goals of total lower lip reconstruction with the exception of the introduction of dynamic tissue and represents a novel solution to a challenging reconstructive problem.

Functional Surgical Approach to the Level I for Staging Early Carcinoma of the Lower Lip

OBJECTIVE: The management of the neck in patients with T1-T2 carcinoma of the lower lip (LLC) remains controversial. Suprahyoid neck dissection seems a reliable diagnostic approach, although it sacrifices the submandibular gland and its vascularity.

STUDY DESIGN AND SETTING: This study was a prospective, randomized study. Patients with previously untreated T1 or T2 primary LLC underwent either classical suprahyoid neck dissection (CSHD) or functional suprahyoid neck dissection (FSHD) in continuity with the resection of the cancer of the lip.

RESULTS: A total of 48 suprahyoid neck dissections were performed in 36 patients. Among these dissections, 27 were CSHD and 21 were FSHD. The average number of dissected lymph nodes was similar for both classical and functional type operations. The overall follow-up period was 40.5 months.

CONCLUSIONS: The end result of this series supports the idea that FSHD is a reliable diagnostic method for the management of level I lymph nodes in LLC. FSHD can avoid undertreatment or overtreatment of the patients with early LLC while preserving the submandibular gland.

Early stage squamous cell carcinoma of the lower lip: predictive factors for recurrence

Objective:

This study aimed to evaluate the effect of tumour thickness on other clinicopathological parameters in early stage lower lip squamous cell carcinoma.

Methods:

Forty-six consecutive patients with lower lip squamous cell carcinoma were included in the study. Demographic, clinical and pathological data were retrospectively collected.

Results:

The mean follow-up period for all patients was 32.0 ± 18.9 months. Forty-four tumours were staged as T1 and two were T2. Twelve patients underwent neck dissection. Two patients presented with neck metastasis in the follow-up period. Four patients (8.7 per cent) had local recurrence. Correlation analysis revealed a significant relationship between microscopic tumour thickness and local tumour recurrence (r = 0.328, p = 0.045).

Conclusion:

Surgical margin control is important to prevent local recurrence, especially in thicker tumours. In addition, neck metastasis is rare in early stage lower lip squamous cell carcinoma. A ‘wait and see’ policy might be preferred in early stage T1 lower lip squamous cell carcinoma cases.

Perioral lesions and dermatoses

The purpose of this article is to review the common neoplasms, infections, and inflammatory dermatoses that may present around or near the mouth. Dental professionals are well positioned to evaluate perioral skin conditions, further contributing to patients' general health. This article includes a review of seborrheic keratosis, warts, actinic keratoses, actinic cheilitis, and squamous cell carcinoma, among several other perioral cutaneous lesions.

Actinic cheilitis and squamous cell carcinoma of the lip: clinical, histopathological and immunogenetic aspects

Actinic cheilitis is the main precancerous lesion of the lip. Squamous cell carcinoma of the lip is reported together with oral carcinomas in the Brazilian official statistics. Overall, they account for 40% of the head and neck carcinomas. In general, physicians and dentists know little about what causes oral tumor development and progression. Tumor suppressor genes and cell proliferation regulatory proteins play a role in the progression of actinic cheilitis to squamous cell carcinoma and in its biological behavior. Knowledge on prognostic and diagnostic markers has a positive impact on the follow-up of these patients.

Cutaneous head and neck squamous cell carcinoma metastatic to cervical lymph nodes (nonparotid): A better outcome with surgery and adjuvant radiotherapy

OBJECTIVE

The aim of this study is to report on the experience of treating cutaneous squamous cell carcinoma (SCC) metastatic to cervical (nonparotid) lymph nodes at the Head and Neck Unit, Westmead Hospital, Sydney, Australia.

STUDY DESIGN

Retrospective chart review.

METHODS

Patients diagnosed with previously untreated metastatic cutaneous SCC to cervical lymph nodes (levels I-V) and treated with radiotherapy, surgery, or surgery and adjuvant radiotherapy were identified. Relapse and outcome was analyzed using Cox regression analysis.

RESULTS

Between 1980 and 2000, 74 patients were treated with curative intent. There were 59 males and 15 females, with a median age of 66 (range 37-93) years. Median duration of follow up was 48 (range 12-187) months. Fifty-two were treated with neck dissection and radiotherapy, 13 with neck dissection alone, and 9 with only radiotherapy. Most patients (85%) had an identifiable index lesion. Level I (38%) and II (36%) lymph nodes were the most often involved. In total, 25 (34%) patients developed recurrent disease, predominantly locoregional (22 of 25). Median time to recurrence was 5.2 (2-34.3) months. Increasing nodal size (> or =3 cm) (P =.01), metastatic spread to multiple nodes (P =.05), and the presence of extranodal spread (P =.01) all predicted for worse survival. Patients undergoing combined modality treatment had a lower relapse rate (15%) and a significantly better disease free survival (P =.001) compared with single modality treatment.

CONCLUSION

Metastatic cutaneous SCC is uncommon but potentially lethal. Surgery and adjuvant radiotherapy remain the best practice and provide the best chance of achieving locoregional control.

Clinical Parameters in T1N0M0 Lower Lip Squamous Cell Carcinoma

This retrospective study was carried out to asses the clinical outcome of T1 (i.e., tumor 2 cm or less at greatest dimension) squamous cell carcinoma of the lower lip (SCCLL) and verify the impact of some clinical parameters on prognosis. Fifty-seven patients with histologically proven T1 SCCLL were analyzed. Fifty-two patients were never treated before admission, whereas five (8.8%) had a second radical resection of the primary tumor location; none had neck nodes (i.e., N0) or distant metastasis (i.e., M0). The global disease-specific survival rate at 32 months was 100%, irrespective of grading and type of surgery, and thus no differences were statistically detected. Therefore, we concluded that radical tumor resection is a viable procedure for T1 SCCLL, irrespectively of grading. In addition, a second surgery on the primary tumor location is possible and has effectiveness on survival. Finally, neck dissection is not necessary in cases of T1 SCCLL.

Lip cancer experience in Mexico. An 11-year retrospective study

Lip cancer is the most frequent malignant neoplasm of the oral cavity; however, there is no information available on the incidence of this type of cancer in Mexico. This study provides information about the clinico-pathological features of lip cancer patients admitted at a cancer hospital in Mexico City during an 11-year period and describes the treatment modalities performed and their results. A total of 113 patients were studied. There were 74 men (65.5%) and 39 women (34.5%), ranging in age from 14 to 106 years (mean 70 years). In 53 cases (46.9%) an association was found between the disease and chronic sun exposure. Additionally, positive smoking antecedents were recorded in 58 cases (51.3%). As 15 patients were followed for less than 1 month, they were excluded for further analysis. There were 82 cases (83.7%) of squamous cell carcinoma, 10 (10.2%) basal cell carcinomas, and one case (1%) each of adenocarcinoma NOS, melanoma, adenoid cystic carcinoma, Merkel cell carcinoma, lymphoepithelioma and angiosarcoma. We observed an incidence of malignant neoplasms in the upper lip of 33.7%, which is higher than most of the published series and may be due to the fact that in this series we included all histological types of lip cancers. Fifty percent of the cases were found in stages III and IV. Cervical lymph node metastases were found in 21% of patients with no previous treatment, and they developed in 5.3% after treatment. Our data suggest that tumoral size is directly related to the possibility of developing node metastases, as none of them occurred in patients T1, whereas 10 (62.5%) of the patients in T4 presented them. Seven deaths were documented (7.1%), five of which corresponded to squamous cell carcinoma, one to Merkel cell carcinoma, and one to adenocarcinoma. Deaths were directly related to the disease in six cases, and one patient died due to surgical complications. Distant metastases were found in only two patients, one of which coursed with an adenocarcinoma and the other with a Merkel cell carcinoma. Based on the present results, we suggest that the differences encountered with respect to other series, particularly the higher incidence found in women, the frequent presentation of this type of neoplasms in the upper lip, the wide variety of histopathological diagnoses and the high frequency of cases with cervical lymph node affection, should lead us to search for multi-modal treatment alternatives in this population.

Squamous cell carcinoma of the lip: is there a role for adjuvant radiotherapy in improving local control following incomplete or inadequate excision?

BACKGROUND

The treatment of squamous cell carcinoma of the lip with surgery is usually curative but incomplete/inadequate excision may be associated with recurrence and poor outcome. There is no consensus in the literature on the definition of an adequate excision margin.

METHODS

Patients treated for squamous cell carcinoma of the lip at Westmead Hospital, Sydney, between 1980 and 2000 were eligible for inclusion. Polytomous logistic regression analysis was undertaken to assess for predictors of recurrence. Recurrence-free and overall survival were calculated using Kaplan-Meier survival curves.

RESULTS

A total of 130 patients was identified. Median age at diagnosis was 64 years (23-97 years). Most lesions (90%) were located on the lower lip in 96 (74%) male patients. Median follow-up duration was 54 months (0-189 months). Most patients -presented with T1 lesions (75%). Initial treatment was surgery (39%), radiotherapy (48%) or both (13%). Twenty-seven per cent of excised lesions had a close (< or =2 mm) or positive margin. A total of 40 patients (31%) had recurrence (18% lymph nodes, 11% lip and 2% both). In the surgery group recurrence was significantly more likely with close or positive margins (P = 0.05). The 2 year -recurrence-free survival was 82% and 54% for radiotherapy and surgery, respectively (P < 0.001). The 2 year overall survival was similar (90% radiotherapy vs 100% surgery; P = 0.58).

CONCLUSION

Incomplete or inadequate excision of some lip cancers results in local recurrence. If re-excision is not feasible -surgeons should consider the role of adjuvant radiotherapy in improving local control.

Supraomohyoid neck dissection in the management of cervical lymph node metastases of squamous cell carcinoma of the lower lip

BACKGROUND

Supraomohyoid neck dissection (SOHND) is generally considered an adequate staging procedure in selected patients with squamous cell carcinoma (SCC) of the lip and oral cavity, with clinically negative nodes in the neck that are at increased risk for occult metastatic disease. The potential role of SOHND as a therapeutic surgical procedure for cervical metastasis limited to level I is controversial.

METHODS

A series of 44 patients with clinical cervical lymph node metastases at level I from SCC of the lower lip is reported to evaluate the results of a treatment protocol consisting of therapeutic SOHND on indication followed by radiotherapy.

RESULTS

Regional recurrences were observed in four (9%) patients. All recurrences developed within the SOHND dissected area only.

CONCLUSIONS

A therapeutic SOHND, on indication followed by radiotherapy, can be an oncologically sound and effective procedure in the management of regional lymph node metastases at level I from SCC of the lower lip.

Squamous cell carcinoma of the lip. Patterns of relapse and outcome: Reporting the Westmead Hospital experience, 1980-1997

Australia has one of the highest rates of squamous cell carcinoma of the lip in the world. Despite a high cure rate, many studies report relapse rates of between 5% and 20% with an associated mortality of 5-10%. The aim of this study was to review the patterns of relapse and outcome for patients treated at Westmead Hospital, Sydney. Ninety-three eligible patients were identified in a retrospective review of all lip cancer patients referred to Westmead Hospital between 1980 and 1997. Relevant data were extracted from the treatment files and included contact with referring doctors and utilizing the Cancer Council Registry. Equal numbers of patients were treated with radiotherapy alone or surgery (+/- adjuvant radiotherapy). The majority of patients were male (78.5%) with T1N0 cancers (64.5%) of the lower lip. A minority (5.4%) had nodal disease at diagnosis. Following treatment, 31 (33.3%) patients relapsed, 11 at the primary site, 18 at the regional nodes and two at both sites simultaneously. Patients treated with a combined approach (RTx/Sx) experienced a better outcome. Overall cancer-specific survival at 5 years was 85%. These findings highlight a disturbing relapse rate and mortality for a subgroup of patients diagnosed with a more aggressive form of lip cancer. Treatment and follow up of these patients should accordingly be more aggressive.

Squamous cell carcinoma of the lip: a retrospective review of the Peter MacCallum Cancer Institute experience 1979-88

BACKGROUND

Squamous cell carcinoma (SCC) of the lower lip is a common malignancy in Australia. Surgical excision and/or radiotherapy are used in treatment, and are regarded as equally effective.

METHODS

A retrospective review of 323 patients treated at the Peter MacCallum Cancer Institute with either surgical excision and/or radiotherapy, evaluated disease recurrence, cause-specific mortality, and the incidence of metachronous lesions.

RESULTS

Recurrence-free survival at 10 years was estimated to be 92.5%, and cause-specific survival at 10 years was estimated to be 98.0%. Equivalent rates of local control were obtained with surgery and radiotherapy. Recurrence was related to tumour stage and differentiation. A high incidence of metachronous lesions was noted, 25 patients had a lesion prior to presentation and 33 patients developed second lip lesions during the study period.

CONCLUSIONS

Squamous cell carcinoma of the lower lip is well treated with surgery or radiotherapy. The preferred treatment for most patients with SCC of the lower lip in the Australian population is surgical excision. This study has shown a significant incidence of metachronous lip neoplasia, except in those patients whose whole lip had been resurfaced.

Cervical lymph node metastases and squamous cell carcinoma of the lip

BACKGROUND

Squamous cell carcinoma of the lip generally has a favorable outcome. The chance of long-term survival is significantly reduced if lymph node metastases develop. Any features that could identify patients having increased risks of occult lymph node metastases would allow more aggressive treatment and, possibly, a better outcome.

METHODS

A chart review of lip cancer from this institution identified 1001 patients with squamous cell carcinoma of the lip. This database was used to identify the characteristics that are associated with occult lymph node metastases.

RESULTS

Delayed cervical lymph node metastases developed in 40 patients. No significant differences were noted in the frequency of delayed lymph node metastases according to gender, lip subsite, or age less than 40 years. Significant differences were noted in association with the tumor size, tumor differentiation, and local recurrence.

CONCLUSIONS

Elective cervical lymphadenectomy is justifiable for higher grade tumors and for locally recurrent tumors. An increase in delayed metastases was observed in patients with tumors greater than 3 cm, but the proportion is not great enough to justify elective neck dissections.

S100+ cell response to squamous cell carcinoma of the lip: inverse correlation with metastasis

Previous work has suggested a key role of dendritic cells in antineoplastic immunity. The course of mycosis fungoides and cancers of the lung, colon, thyroid and stomach has been associated with dendritic cell response to the primary tumor. However, this has not been reported for cutaneous or mucosal squamous cell carcinoma (SCC). Thirty-six cases of primary SCC of the lip mucosa or vermillion border, including nine cases with regional metastasis, were studied to investigate the relationship of dendritic cell density with age, tumor grade, mitotic rate, diameter, ulceration, depth of invasion, muscle invasion, tumor-infiltrating lymphocytes (TILs) and metastasis. Dendritic cells were identified using S100 immunohistochemistry, and their peritumor and intratumor density (peri-S100D and intra-S100D) were determined. The mean peri-S100D was 314 +/- 50/mm2. High peri-S100D was associated with lower rate of metastasis (P = 0.03), and no case with peri-S100D > 311/mm2 metastasized. Peri-S100D inversely correlated with depth of invasion (P = 0.04) and ulceration (P = 0.02), and positively associated with TILs (P = 0.02). The mean intra-S100D was 317 +/- 42/mm2. Intra-S100D did not quantitatively correlate with metastasis; however, no metastasis occurred when intra-S100D exceeded 515/mm2. Intra-S100D correlated with brisk TILs (P = 0.04). These results suggest a functional role of dendritic cells in the immune response to SCC. Peri-S100D may be a prognostic indicator.

Perineural invasion of the lower alveolar nerve by oral cancer: a follow-up study of 12 cases

Twelve previously untreated cases of oral cancer with perineural infiltration were studied retrospectively. Age, sex, site, clinical stage and outcome were evaluated. Management of the neoplasm in each case involved surgical removal and six patients required adjuvant radiotherapy. The most frequent site was the lip. At the time of diagnosis, five patients had sensory complaints and palpable lymphadenopathy was observed in three patients. The 5-year crude survival rate was 16.7%. In the cases with postoperative assessment of perineural infiltration, a median survival time of 30.8 months was observed; while in the case of preoperative assessment of nerve infiltration, extensive surgery was performed with a consequent median survival time of 44.5 months. The perineural infiltration of the lower alveolar nerve is more common (6.3%) than is generally thought. This frequency is due to the relationship with the lower lip and the mandibular region. In carcinoma of the lip, spread is generally limited to 10-15 mm along the lower alveolar nerve. In carcinoma of the mandibular region, spread is entirely dependent on the location of the tumour; the absence of clinical fixation to the bone and the small size of the carcinoma does not preclude the possibility of bone involvement. Neurological symptoms should be evaluated carefully, and a radiographic investigation of the nerve canal is mandatory.

Surgical treatment of squamous cell carcinoma of the lower lip: evaluation of long-term results and prognostic factors--a retrospective analysis of 184 patients

PURPOSE

A retrospective study was undertaken to evaluate the results of surgical treatment of primary squamous cell carcinoma of the vermilion border of the lower lip and to identify parameters of the primary tumor that may predict local recurrence and regional metastasis.

PATIENTS AND METHODS

From 1979 through 1992, 184 consecutive patients with a primary squamous cell carcinoma of the lower lip underwent surgical excision as a primary treatment. There were 166 (90.2%) men and 18 (9.8%) women, with a mean age of 66 years. Most cases (92.9%) were stage I tumors. Most of the tumors were well and moderately differentiated squamous cell carcinomas (93.5%). Minimal follow-up was 2 years, with a mean of 56 months. Disease control was achieved in 165 (89.7%) patients. Local recurrence and regional metastasis occurred in 9 (4.9%) and 10 (5.4%) patients, respectively. Local failures were treated successfully by either surgery or radiation therapy. Regional metastases were treated in nine patients by neck dissection, followed in eight cases by radiation therapy. One patient developed distant metastasis.

RESULTS

Five- and 10-year overall survival rates were 78% and 61%, respectively, whereas the disease-free survival rates at 5 and 10 years were 86% and 81%, respectively. Multivariate analysis indicated that local recurrence was significantly associated with large tumor size and surgical margins containing squamous cell carcinoma. Increasing tumor thickness, an infiltrative invasion pattern, and perineural invasion were significant prognostic indicators of regional metastasis.

CONCLUSION

Surgical treatment for small squamous cell carcinomas of the lower lip has a favorable prognosis. Particular parameters of the primary tumor seem to predict the chance of development of local recurrence and regional lymph node metastasis.

Histological correlates of metastasis in primary invasive squamous cell carcinoma of the lip

The histological features of 66 cases of squamous cell carcinoma of the lip were studied in an attempt to define prognostic parameters. Features that correlated with an increased risk of metastasis included histological grade of the tumour at the base and the surface, the tumour thickness, presence of stromal sclerosis, and the presence of muscle and perineural invasion.

Results of radiotherapy for squamous cell carcinoma of the vermilion border of the lower lip. A retrospective analysis of 108 patients

The authors analyzed the clinical history, tumor histology and stage, and outcome of a group of 108 patients with squamous cell carcinoma (SCC) of the vermilion border of the lower lip who underwent radiation therapy in the period between 1980 and 1992. The median follow-up was 77 months. The disease stages were T1 in 89 (82.4%), T2 in 17 (15.7%), and T3 in 2 cases (1.9%). At presentation, regional lymph nodes were clinically negative in all but 3 patients. The total tumor dose varied from 48 Gy to 70 Gy, depending on the radiation modality (orthovoltage, electrons, photontherapy and iridium implants). Local control was achieved in 88 out of 89 (98.9%) patients with T1, in 13 out of 17 (76.5%) patients with T2 and in both patients with T3 tumors. Local treatment failures (4.6%) were cured by salvage surgery. During follow-up, regional lymph node metastases at level I (submental and submandibular groups) occurred in 11 out of 89 (12.4%) patients with stage I and in I out of 15 (6.7%) patients with stage II tumors. All these patients underwent therapeutic neck dissection, followed by radiotherapy in 8 cases. Two patients developed distant metastases. Thus, after salvage treatment of local failures and regional metastases the total group of patients with stage I and II SCCs of the vermilion border of the lower lip showed a definitive control rate of 98.1%.

Squamous cell carcinoma of the lips in a northern Greek population. Evaluation of prognostic factors on 5-year survival rate--I

The purpose of this study was to determine the clinical features of squamous cell carcinoma (SCC) of the lips, along with its prognostic factors, in order to extend and update the information related to lip cancer in northern Greece and to provide a basis for international comparison. Records of 1510 patients with SCC of the oral cavity presented at the Theagenion Anticancer Institute of Thessaloniki, Greece from 1979 and 1989 were reviewed. The most common site for oral squamous cell carcinoma (OSCC) was found to be the lips (59.4%) as compared to 40.5% of intra-oral SCC. Males were affected more frequently, presenting a ratio of 9.2:1. The peak age of incidence was found to be the 6th decade for men and the 8th for women. Rural residents and outdoor workers were affected more than urban residents (79.9% versus 28.1%). Most of the patients were diagnosed in early categories and early clinical stages of the disease. Almost all (98.5%) were classified into T1 and T2 categories, and 92.9% into stages I and II. A total of 7.59% of patients presented with clinically-positive lymph-node involvement. Most of them were classified as an advanced stage of the disease. Primary surgical excision was performed on 60.14%, radiotherapy on 35.14%, a combination of these on 2.47%, and chemotherapy alone or in combination with the above regimens in 2.22% of the cases. The outcome was adequate for surgery, radiotherapy, and the combination of the two, since 91.3, 74, and 90%, respectively, survived for more than 5 years. An overall 5-year survival rate of 83.3% was found. Our findings showed that the survival rate was significantly influenced by the main prognostic factors, such as the size of the tumour, the lymph-node involvement, the clinical stage of the disease and the histologic differentiation. SCC of the lips continues to be the most common site of oral cancer development amongst the Greek population. The aetiologic significance of actinic radiation for SCC of the lips is confirmed by our findings. The main prognostic factors proved to significantly influence the survival of our patients. Our results support the fundamental principal of head and neck cancer, i.e. that early detection of the primary tumour is the best prognostic factor for increasing survival rates. Therefore, public awareness concerning the disease, and better education for health care workers which will provide a thorough knowledge for the prognosis of oral cancer and the factors influencing it, is necessary.

Lymph-node metastasis in squamous cell carcinoma of the lip. A retrospective analysis of 105 cases

During 1975-87, 105 patients with squamous cell carcinoma (SCC) of the lip were surgically treated. All patients underwent radical resection of the tumor. Only the patients with palpable lymph nodes had a simultaneous neck dissection. All patients were followed up for at least 5 years. Of the 80 patients without palpable lymph nodes, only three developed lymph-node metastasis. Of the 25 patients with palpable lymph nodes who underwent modified neck dissection, four had recurrence of lymph-node metastasis at a different level. The over-all 5-year survival rate was 97%. The survival rate for patients with lymph-node metastasis was 88%.

Brachytherapy for lower lip epidermoid cancer: tumoral and treatment factors influencing recurrences and complications

From 1972 to 1991, 237 patients with squamous cell carcinoma of the lower lip were treated by exclusive LDR brachytherapy (192Ir). There were 158 T1, 61 T2, 17 T3 and 1 T4 with 231 N0, 3 N1 and 3 N2 patients. The actuarial values at 5 years for local and regional controls, overall and specific survivals were 95%, 91%, 74% and 91%. Salvage treatment increased local control up to 99% and regional control to 94%. No heterolabial recurrence has been observed since the entire lip is treated, even for small tumors. The regional control depends closely on the thickness of the labial tumor (> or = 1 cm, p < 0.0001). The healing of treatment-induced mucositis is sometimes delayed for thick tumors (> or = 1 cm, p = 0.015). Late complications are not related to tumoral thickness but to the treated thickness (> 1.4 cm, p = 0.018) and particularly to the thickness of normal tissue included in the 85% isodose (treated thickness - tumoral thickness > 0.4 cm, p = 0.025). The use of a leaded protection and low linear radioactivity wires (< 2 mCi/cm, < 8.6 muGy/h.m2/cm) especially for large target volumes is required to lessen late complications. Based on this review, we advocate exclusive brachytherapy for small and intermediate tumors, with elective bilateral submaxillary and submental dissection for thick, high grade or commissure tumors. Simple recommendations are made to assure quality of the brachytherapy treatment.

Histologic correlates of metastasis in primary invasive squamous cell carcinoma of the lip

Clinical and histologic features of 44 invasive squamous cell carcinomas of the lip treated by surgical excision were correlated with metastases and survival. Age, diameter, ulceration, grade, depth of invasion, muscle invasion, mitotic rate, lymphatic-vascular invasion, and tumor infiltrating lymphocytes were evaluated. Two (4.5%) patients had local recurrence, 10 (23%) had metastases to cervical lymph nodes, and 2 (4.5%) died from complications of extensive spread in the neck. One patient with local recurrence had regional node metastases. Regional metastases were discovered at the time of (3 patients) or up to 21 (median 8) months after initial diagnosis, correlating with ulceration (P = 0.003), depth of invasion (P = 0.0001), and mitotic rate (P = 0.05) of the primary tumor. Depth exceeding 2.0 mm. was associated with metastasis (P = 0.028), and all carcinomas deeper than 6.0 mm. metastasized. Eight of the 10 patients with regional metastases had no further disease after treatment through the follow-up period (median 64 months). Both fatalities were older (median 81 years) men. These results underscore the metastatic potential of invasive squamous cell carcinoma of the lip. Histologic analysis of the primary lesion can be used to identify individuals at risk.