Lip carcinoma: clinical presentation, surgical treatment, and outcome: a series of 108 cases from Denmark

"High-risk" tumors of the lip treated with external beam radiotherapy and high-dose-rate brachytherapy: Long-term outcome

BACKGROUND

Radiotherapy is a well-established treatment for lip cancer, with external radiotherapy (EBRT) or brachytherapy (BT).

METHODS

This study evaluated outcome, tumor control, and aesthetics, for 101 patients with carcinoma of the lip, not suitable for surgery, treated with combined EBRT and BT.

RESULTS

Squamous cell carcinoma was seen in 78 patients, basal cell carcinoma in 15, and other histologies in 8 patients. Tumors were advanced: 73% in category T2-T4. Local control at 3 and 5 years was 89%. Local failure appeared in 4/56 patients (7%) with primary RT compared to 7/45 (16%) in those with prior surgery, regional recurrence in 5 patients. Toxicity was mild. Cosmetic outcome, 87 patients evaluated, was bad for 9/40 patients with upfront surgery compared to 1/47 for primary RT patients (p = 0.003). Seven patients died from lip cancer (7%), three with originally N+ disease (43%).

CONCLUSIONS

Combined EBRT and BT could be considered for lip tumors not candidates for surgery.

Squamous cell carcinoma of lip: Clinical feature analysis and suggestion of reconstruction algorithm

Reconstruction of lips after squamous cell carcinoma (SCC) removal should restore functional and aesthetic roles; however, it remains a challenge. In this study we describe the clinical features of lip SCC and suggest a reconstruction algorithm. We retrospectively analyzed 34 patients with lip SCC who underwent reconstruction after Mohs micrographic surgery between January 2006 and March 2022. The mean age of the patients was 70.2 years. Seven tumors were on the upper lip and 27 tumors were on the lower lip. Twenty-five defects were located on the mucosal lip, eight defects involved both the mucosal and cutaneous lips, and one defect was confined to the cutaneous lip. Eighteen defects were smaller than 50% of the total lip size, and 16 were larger than 50%. Primary closure was mostly performed for defects smaller than 50% of the lip size (9/18 cases), and local flap, according to the location and size of the defects, was performed for larger defects. Thirteen patients experienced postoperative complications but improved within 1 year after surgery, except for one patient. We suggest a reconstruction algorithm with a 50% cut-off value. Defects smaller than 50% of the lip size could be reconstructed by primary closure. Even larger defects could be reconstructed by creation of a local flap from the remaining adjacent tissue with minimal postoperative complications.

Long-term outcomes, quality of life, and costs of treatment modalities for T1-T2 lip carcinomas

PURPOSE

Early stage lip squamous cell carcinoma (lip SCC) can be treated with conventional excision, Mohs micrographic surgery (MMS), or brachytherapy. The aim of this retrospective study was to describe the medical outcomes, patient-reported outcomes, and costs of these treatments.

METHODS

A retrospective cohort study of T1-T2 lip SSCs treated between 1996 and 2019. Medical outcomes, recurrences, and survival were retrieved from medical records. Facial appearance, facial function, and Quality of Life (QoL) were measured with the Face-Q H&N and EQ-5D-5L questionnaires. Costs were also calculated.

RESULTS

Of the 336 lip SCCs, 122 were treated with excision, 139 with MMS, and 75 with brachytherapy. Locally, the recurrence rate was 2.7% and regionally 4.8%. There were 2% disease-related deaths. T2-stage and poor tumor differentiation were associated with recurrences. Posttreatment QoL, facial function, and appearance were rated as good. Brachytherapy was the most expensive treatment modality.

CONCLUSION

Early-stage lip SCC has a good prognosis, with a disease-specific survival of 98.2% after a median follow-up of 36 months, there was a high QoL and satisfaction at long-term follow-up. Based on the costs and the risk of locoregional recurrences, we believe that, for most noncomplex lip SCCs, MMS would be the most logical treatment option.

Lower lip basal cell and squamous cell carcinomas: a reappraisal of the similarities and differences in clinical presentation and management

Basal cell carcinoma and squamous cell carcinoma are the two most common types of carcinomas, affecting a total of 5.4 million people each year in the United States. Sun-exposed areas, especially the face and nose, are most affected given the strong association between these carcinomas and ultraviolet radiation. Less research has been done surrounding carcinomas of the lip, despite the significant aesthetic and functional importance of this area. Although lip carcinomas tend to follow a classic, unique distribution pattern that favors basal cell carcinoma on the upper lip and squamous cell carcinoma on the lower lip, more cases of lower lip basal cell carcinoma are being reported, warranting further educational awareness to differentiate carcinomas of the lower lip. In this article, we provide an updated overview of the risk factors, presentations, differential diagnoses, metastatic risks, evaluation, management guidelines, and outcomes of lower lip carcinoma. Of note, recent advances in imaging modalities are beginning to show promise as a non-invasive, affordable, and rapid way to detect and stage tumors. We conclude that increased clinical awareness and investigation of lower lip carcinoma is needed to improve early intervention, as a delayed diagnosis can rapidly alter the management and outcomes of lip carcinomas.

Recurrent squamous cell carcinoma of the lower lip: salvage surgery outcome

Squamous cell carcinoma (SCC) of the lip is one of the most commonly occurring oral cancers, mainly involving the lower lip. Despite a good prognosis in cases of early detection, survival rates drop dramatically in the presence of recurrence. While there are many studies in the literature regarding the management of primary tumours, the rate of recurrence in lower lip SCC is low and therefore there are few data and articles about them. We retrospectively reviewed patients affected by recurrent SCC of the lower lip treated surgically from 2011 to 2019 in a single centre. Data and results were compared with those in the literature. A total of 16 patients (mean [range] age: 78.1 [62-93] years) were eligible for inclusion. The disease-free survival rate at 2 and 5 years was 29.6% and the overall survival rate at 2 and 5 years was 14.4%. A significantly higher rate of failure and a worse prognosis was observed in patients with neck involvement. The prognosis of recurrent lower lip SCC is unfavourable with extremely low survival rates. This issue is probably linked to the oncological pathology but also to the advanced age of most patients, the presence of several comorbidities and, consequently, the high risk of perioperative mortality. For this reason, the analysis of data sets reported in the literature may help the surgeon in the management of recurrences and selection of patients.

Nomogram predicting long-term overall survival and cancer-specific survival of lip carcinoma patients based on the SEER database: A retrospective case-control study

Our study was designed to construct nomograms to predict the overall survival (OS) and cancer-specific survival (CSS) of lip carcinoma patients.A search of the Surveillance, Epidemiology, and End Results (SEER) database provided us with detailed clinical data of the 1780 lip carcinoma patients. On the basis of the credible random split-sample method, the 1780 patients were placed into 2 groups, with 890 patients in the modeling group and 890 patients in the counterpart's group (proportion = 1:1). By employing Kaplan-Meier univariate and Cox multivariate survival analyses based on the modeling cohort, the nomograms were developed and then used to divide the modeling cohort into low-risk cohort and high-risk cohort. The survival rates of the 2 groups were calculated. Internal and external evaluation of nomogram accuracy was performed by the concordance index (C-index) and calibration curves.With regard to 5- and 8-year OS and CSS, the C-indexes of internal validation were 0.762 and 0.787, whereas those of external validation reached 0.772 and 0.818, respectively. All the C-indexes were higher than 0.7. The survival curves of the low-risk cohort were obviously better than those of the high-risk cohort.Credible nomograms have been established based on the SEER large-sample population research. We believe these nomograms can contribute to the design of treatment plans and evaluations of individual prognosis.

Lower lip squamous cell carcinoma: A Vietnamese case report of surgical treatment with reconstruction by local flap

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Many risk factors including age, sex, chronic exposure to solar radiation, tobacco, alcohol consumption, viral factors autoimmune diseases and using immunosuppressant drugs are associated with developing lip cancer.

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Treatment with tumor excision, lymph node dissection and reconstruction by local flap is primary treatment for patients with lower lip cancer.

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Bilateral V-Y advancement flap can be utilized in the reconstruction of lip cancer in case of large defect, as well as guarantee safety and adequate cosmetic and function for low-income patients.

Introduction

Squamous cell carcinoma (SCC) of lower lip comprises over 25% of oral cancer. Surgical treatment plan for SCC patients includes tumor excision, lymph node dissection and reconstruction.

Case presentation

A 68-year-old patient was admitted with 1-year history of tumor in his lower lip. Examination revealed a large lower lip tumor with expansion to the upper lip and a 2 cm submental lymph node. Biopsy result of the tumor was SCC and fine needle aspiration result of the lymph node was metastasis SCC. He underwent a complete removal of the lower lip and 1/3 external of the upper lip plus dissection of bilateral cervical lymph node plus reconstruction with local flap. After a 4-hour operation and 14-day hospitalization, patient recovered with flap in excellent condition and without any complications.

Conclusion

Treatment with tumor excision, lymph node dissection and reconstruction by local flap is primary treatment for patients with lower lip cancer. Choice of reconstruction method depends on various factors, whereas V-Y advancement flap presents dominant advantage in lower lip cancer treatment.