Lip carcinoma C00.0-C00.1

Author: Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 03.03.2023

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Synonym(s)

Carcinoma of the lip; Carcinoma spinocellulare of the (lower) lip; Cheilocarcinoma; Lip Cancer; Lip carcinoma

Definition
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Squamous cell carcinoma(spinocellular carcinoma) of the red of the lips

Classification
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Classification (according to Dösak, 1995):

T1: tumours < 5 mm tumour thickness (histometric, TD), 5-year survival rate: 80%.
T2: tumours 5-10 mm TD, 5-JÜB: 68%.
T3: tumours 10-20 mm TD, 5-JÜB: 54%.
T4a: tumours > 20 mm TD (up to 20 mm clinical diameter), 5-JÜB: 21%.
T4b: Tumours > 20 mm TD (> 20 mm clinical diameter), 5-JÜB: 21%.

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Etiopathogenesis
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Poor oral hygiene, chronic trauma caused by poorly fitting dentures or tooth edges, actinic damage, smoking. Mostly development from precancerous lesions such as oral leukoplakia, cheilitis actinica, cheilitis abrasiva praecancerosa.

Manifestation
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Preferably occurring in middle-aged or older men.

Localization
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Centrofacial mainly on the lower lip, never on the upper lip! Frequent infiltration of the M. orbicularis oris.

Clinical features
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On previously damaged skin, formation of a small, flat, clearly increased consistency, crust-covered ulceration. Continuous endo- and exophytic growth; distending of the lip. Distortion of the corners of the mouth. Metastasis in regional and distant lymph nodes in about 15% of patients.

Histology
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Histopathological prognostic criteria (according to AWMF guidelines
PT category	Definition of the forecast group	Metastasis rate
PT1-3a	limited to dermis and tumour thickness up to 2.0 mm	0%
PT1-3b	limited to dermis and tumour thickness > 2.0 mm to 6.0 mm	about 6%
PT1-3c	Invasion of the subcutis and/or tumour thickness > 6.0 mm	about 20% of
pT 4a	Infiltration of deep extradermal structures (T4): 6.0 mm or < 6.0 mm	about 25% of
pT 4b	Invasion of deep extradermal structures (T4): > 6,0 mm	up to about 40%.

Differential diagnosis
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Keratoakanthoma; verrucous leukoplakia; verrucae vulgar; syphilitic primary effect.

Therapy
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Surgery with histological margin control. With the exception of major reconstructive surgery or simultaneous regional lymphadenectomy, lip surgery can be performed under local anesthesia. Therapy options are based on tumor thickness. (no risk: TD ≤ 2.0 mm; low risk: TD ≤ 2.1-5.0 mm; high risk: TD > 5.0 mm).

Severe and extensive precancerous lesions as well as flat (low-risk) carcinomas that remain confined to the labial red:
- Superficial removal of the red of the lip, mobilization of oral mucosa, which is pulled outwards and sutured to the lip skin by means of single button sutures (Vermillion plasty).
- Alternatively (especially in older multimorbid patients): cryosurgery with nitrogen in an open spray procedure (2 times cycle); side effects: considerable lip swelling.
In tumor localizations in the labial red or near the labial red border:
- W-shaped excision of the defect and covering of the defect by means of an arterial pedicled flap from the upper lip (Abbe-plasty); the flap is cut after about 4 weeks.
- Alternatively: V-shaped excision of the defect and covering of the defect from the lateral part of the upper lip (Estlander-plasty), a flap cutting is not necessary, because the defect is limited to the lateral part of the lip. If necessary, an extension plasty of the corner of the mouth can be performed after one year.
For medially localized tumors occupying more than half of the lower lip or classified as "high risk" tumors: Penetrating, wedge-shaped, micrographic excision.
- The defect is covered either by means of an incision made in extension of the corners of the mouth, reaching through all 3 layers of the cheek, as well as a medial incision reaching to the chin, displacement of both flaps medially (V-shaped defect coverage), lip replacement plastic from the oral mucosa (Dieffenbach plastic).
- Alternatively: Incision extension also performed in extension of the corners of the mouth, excision of Burow triangles in the area of the nasolabial folds, defect coverage by shifting medially, lip replacement from the oral mucosa (Bernhard-Burow-Bruns-Plasty).
- In addition, in the case of very large defects, a Z- or WY-plasty can be performed to improve the aesthetic result in the chin area.
In the case of pre-existing lymph node metastases in the cervical lymph nodes:
- En bloc resection of the tumor with simultaneous neck dissection on the affected side of the neck, defect coverage by latissimus dorsi or pectoralis plasty, in case of inoperability possibly radiotherapy (see also carcinoma, spinocellular) or chemotherapy or multimodal therapy.
If distant metastasis has already occurred:
- Surgical reduction of the tumor mass as far as possible followed by chemotherapy (see also carcinoma, spinocellular).
- Alternative: Multimodal therapy (see also Carcinoma, spinocellular).

Prophylaxis
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Avoidance of alcohol and nicotine, dental care and cleaning. Avoid strong sun exposure ( light protection). Treatment of precanceroses.

Literature
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Kumar P et al (2002) Incomplete excision of basal cell carcinoma: a prospective multicentre audit. Br J Plast Surg 55: 616-622
Mozafari N et al (2022) Hypertrophic lichen planus on lip mimicking SCC. Clin Case Rep10:e6191.
Petres J et al (1996) Operative dermatology. Springer Verlag, Berlin Heidelberg New York pp. 277-305.
Pietersma NS et al (2015) No evidence for a survival difference between upper and lower lip squamous cell carcinoma. Int J Oral Maxillofac Surg doi: 10.1016/j.ijom.2014.10.024
Saldanha G, Fletcher A, Slater DN (2003) Basal cell carcinoma: a dermatopathological and molecular biological update. Br J Dermatol 148: 195-202
Schwenzer N (1990) Plastic and reconstructive oral and maxillofacial surgery. In: Schwenzer N, Grimm G: Zahn-Mund-Kiefer-Heilkunde - Spezielle Chirurgie. Georg Thieme Verlag Stuttgart pp. 670-769.
Thanh Pham T et al. (2015) Squamous cell carcinoma of the lip in Australian patients: definitive radiotherapy is an efficacious option to surgery in select patients. Dermatol Surg 41:219-225