Squamous Cell Carcinoma of the Lip

Abstract

Aim of the study: To characterize the current population of patients with squamous cell carcinoma of the lip with focus on the biological behavior and prognosis of these tumors. To evaluate the lip cancer treatment at the department of maxillofacial surgery in Pilsen. Methods: The retrospective study included 72 patients with 73 lip squamous cell carcinomas diagnosed and treated within seven years (January 2002 - December 2008). Clinical and demographic parameters were identified and evaluated. Results: Patients mean age was 73.2 ± 9.5 years. Male to female ratio was 2,4:1. The lower lip was affected in 68 cases (93%), upper lip in 5 cases (7%). The persistence of a lip tumor before a medical examination (identified in 55 patients) was on average 7.2 months. T1 tumors were diagnosed in 60 cases (83%), T2 in 12 cases (16%) and T4 in one case (1%). Regional lymph node metastases were not detected at the time of diagnosis in any patient (N0). Histological grading (identified in 54 tumors) was: G1 - 39 tumors (72%), G2 - 13 tumors (24%), G3 - 2 tumors (4%). Histologically verified actinic cheilitis was observed in 15 patients (21%), in one patient the lip cancer had origin in oral lichen planus. Immunodeficiency was detected in four patients (6%). 43 patients had medical record of smoking cigarettes, nine (21%) of them were smokers, 34 (79%) were non-smokers. Synchronous or metachronous non-melanoma skin cancer of the head and neck occurred in 11 patients (15%). Primarily all patients were treated surgically. Follow-up period was on average 48.3 months (median 44.5). Seven patients (10%) developed regional lymph node metastases during the follow-up on average 26.3 months from the time of diagnosis. Distant metastasis was detected in one patient (1,39%) with the terminal stage of disease. Local recurrences were observed in five patients (7%) on average 15 months after the surgery. Oncological therapy was indicated in nine patients (13%). 5 patients died as a consequence of cancer, an average of 15.6 months from the time of diagnosis (mortality 7%). Complete remission of malignant disease was achieved in 92% of patients (in 86% of patients only by the surgery alone). Conclusion: In the Czech Republic a squamous cell carcinoma of the lip is diagnosed most often in the 1st clinical stage. It is a slow growing, well differentiated tumor affecting the lower lip with a low metastatic potential to regional lymph nodes in most cases. Although these tumors are supposed to have a good prognosis, they may have a lethal course even in the cases of small size and well differentiated tumors because of recurrences or metastatic disease. A lymph node involvement may not be detectable at the time of diagnosis. That's why follow-up is necessary for all patients. Screening of premalignant lesions and lip squamous cell carcinomas should be a role for all physicians performing head and neck examination because of a well examinable localization.

Keywords

• squamous cell carcinoma
• spinalioma
• lip
• lip cancer