Surgical management of squamous cell carcinoma of the lip

Abstract

This chapter will discuss the surgical management of squamous cell carcinoma (SCC) of the upper and lower lips in relation to the primary tumor, regional disease, and recurrent disease. In order to plan the most effective surgical approach, clinical examination and head and neck imaging are required to accurately stage the tumor and assess the presence of regional metastases. Biopsy is essential to confirm the diagnosis, assess the tumor thickness and histologic grade, and look for other prognostic information such as perineural involvement and mode of invasion. In larger tumors clinical examination and CT scanning to rule out mandibular involvement and neurological testing combined with MRI to assess the mental nerve may be necessary. In T3–4 tumors where the risk of occult nodal metastasis is increased (Positron Emission Tomography), PET scan may be useful especially for the upper lip where the primary echelon nodes may be in the intra-parotid nodes rather than the cervical nodes. Finally a distant metastatic work-up is rarely warranted as most lip cancers present early (stages I–II) and distant metastases are very rare. In one analysis of bone metastases, only 4 of 186 cases of lip carcinoma (2.14 %) showed bone metastasis, (one with associated axillary nodes). All cases were stages II–IV.