Squamous Cell Carcinoma of the Lower Lip; Is Prophylactic Neck Dissection Required and Evaluating Predictive Factors

Objective: This research introduces a series of 87 cases of squamous cell carcinoma of the lower lip. We aim to evaluate the efficacy of prophylactic neck dissection and assess determinative factors for local recurrence and regional metastasis in lower lip carcinomas.Methods: Medical records of 87 consecutive patients who were diagnosed with squamous cell carcinoma (SCC) of the lower lip were retrospectively analyzed for specific parameters at the Ear Nose Throat (ENT) and Plastic & Reconstructive Surgery clinic at the Dr. Ersin Arslan Training and Research Hospital and the ENT clinic at the Gaziantep University School of Medicine between 2011 and 2017. Patients who had been previously operated upon in other centers were excluded from the study. Tumor excision with safe margins confirmed by frozen sections and supraomohyoid neck dissection was performed on all the patients involved in this study. The mini-mum follow-up was 12 months for all patients. The median follow-up was 23 months (ranging from 12 to 72 months).Results: The data analysis indicated that local recurrence was significantly related to the tumor size, depth, and proximity of the tumor to surgical margins. Local recurrence was detected in 8 (9.1%) of 87 patients. Time from onset of disease to the diagnosis, size of the tumor, and proximity of the tumor to the lip commissure play an important role in the spread regional metastasis. Over-all the regional metastasis rate was found to be 22.9% (20 of the 87 patients). The occult metastasis rate was found to be 9.1% (8 of the 87 patients). The overall survival rate of patients with lower lip carcinoma, who underwent a supraomohyoid neck dissection and excision of the tumor was 96.5% (84 of the 87 patients).Conclusion: Although lower lip cancers generally have a good prognosis after a proper surgical intervention, it can be life-threaten-ing in case of neck metastasis or local recurrence. Certain factors, such as tumor size, location, and time interval between onset of dis-ease and diagnosis are influencing the prognosis. Prophylactic neck dissection should be performed when the risk of cervical lymph node metastases is high in patients, especially to cases in which the tumor is close to the commissure. Early detection, prophylactic neck dissection, and follow-up with frequent intervals are essential for a good prognosis.

PDF

___

1. Vukadinovic M, Jezdic Z, Petrovic M, Medenica LM, Lens M. Surgical management of squamous cell carcinoma of the lip: Analysis of a 10-year experience in 223 patients. J Oral Maxillofac Surg 2007; 65: 675-9. [CrossRef ]
2. Casal D, Carmo L, Melancia T, Zagalo C, Cid O, Rosa-Santos J. Lip can-cer: A 5-year review in a tertiary referral center. JPRAS 2010; 63: 2040-5. [CrossRef ]
3. Moore SR, Johnson NW, Pierce AM, Wilson DF. The epidemiology of lip cancer: A review of global incidence and etiology. Oral Dis 1999; 5: 185-95. [CrossRef ]
4. Salgarelli AC, Sartorelli F, Cangiano A, Pagani R, Collini M. Surgical treatment of lip cancer: Our experience with 106 cases. J Oral Maxil-lofac Surg 2009; 67: 840-5. [CrossRef ]
5. de Visscher J, Gooris RJJ, Vermey A, Roodenburg JLN. Surgical mar-gins for resection of squamous cell carcinoma of the lower lip. J Oral Maxillofac Surg 2002; 31: 154-7. [CrossRef ]
6. Brodland DG, Zitelli JA. Surgical margins for excision of primary cu-taneous squamous cell carcinoma. J Am Acad Dermatol 1992; 27: 241-8.[CrossRef ]
7. Lydiatt W. Management of lower lip cancer: A retrospective analysis of 118 patients and review of the literature. Arch Facial Plast Surg 2003; 5: 533. [CrossRef ]
8. Khalil HH, Elaffandi AH, Afifi A, Alsayed Y, Mahboub T, El Refaie KM. Sentinel lymph node biopsy (slnb) in management of n0 stage t-1-t-2 tip cancer as a “same day” procedure. Oral Oncol 2008; 44: 608-12.[CrossRef ]
9. Yilmaz S, Ercocen AR. Is elective neck dissection in t1-2, n0 patients with lower lip cancer necessary? Ann Plast Surg 2009; 62: 381-3. [CrossRef ]
10. Bucur A, Stefanescu L. Management of patients with squamous cell carcinoma of the lower lip and N0-neck. J Craniomaxillofac Surg 2004; 32: 16-8. [CrossRef ]
11. Altinyollar H, Bulut H, Berberoglu U. Is suprahyoid dissection a diag-nostic operation in lower lip carcinoma? J Exp Clin Cancer Res 2002; 21: 29-30.
12. Fukushima S, Masuguchi S, Igata T, Harada M, Aoi J, Miyashita A, et al. Evaluation of sentinel node biopsy for cutaneous squamous cell carcinoma. J Dermatol 2014; 41: 539-41. [CrossRef ]
13. Luna-Ortiz K, Guemes-Meza A, Villavicencio-Valencia V, Mosque-da-Taylor A. Lip cancer experience in mexico. An 11-year retrospec-tive study. Oral Oncol 2004; 40: 992-9. [CrossRef ]
14. Schüller M, Gosau M, Müller S, Gerken M, Rohrmeier C, Legal S, et al. Longterm outcome and subjective quality of life after surgical treat-ment of lower lip cancer. Clin Oral Investig 2015; 19: 1093-9. [CrossRef ]
15. Zitsch RP, Lee BW, Smith RB. Cervical lymph node metastases and squamous cell carcinoma of the lip. Head Neck 1999; 21: 447-53. [CrossRef ]
16. Uglesic V, Amin K, Dediol E, Kosutic D. Combined Kara-pandzic-Abbé/Estlander/Stein flap for subtotal and total lower lip reconstruction. J Plast Reconstr Aesthet Surg 2019; 72: 484-90. [CrossRef ]
17. Gargiulo M, Serra Mestre JM, Cortese A, Murphy DC, Parascandolo S, Razzano S. Long term effectiveness of electrochemotherapy for the treatment of lower lip squamous cell carcinoma. J Craniomaxillofac Surg 2018; 46: 1968-74. [CrossRef ]