SCCA OF THE LIP

STAGING OF LIP AND ORAL CAVITY CANCER

Same as Oral Cavity and Oral Pharynx
T-stage

T1 ≤ 2 cm
T2 2 to 4 cm
T3 > 4 cm
T4 invades cortical bone,
deep muscle of tongue
maxillary sinus
or skin of face

N-stage

N1 Single ipsilateral LN, ≤ 3 cm
N2 Single ipsilateral LN, 3-6 cm
multiple ipsilatera LN, < 6 cm
N3 > 6 cm

TERMS

  • "Small lesions"
    • < 1/2 of lip (3.5 cm)
  • "Large lesions"
    • > 1/2 of lip (3.5 cm)
  • "Advanced lesions"
    • pT4: infiltration of skin, muscle or bone
    • commissure and buccal mucosa
    • nerve (mental nerve)

SURGERY ALONE

Indications

  • "Small lesions" (< 2cm) with
    • well-differentiated histology
    • NO commissure involvement

Vermilionectomy

Vermil

Surgical Complications

  • drooling secondary to oral incompetence

RADIATION ALONE

Indications

  • "Small lesions" with
    • moderately or poorly differentiated
    • commissure involvement
  • "Large lesions" w/o
    • bone or
    • nerve involvement

COMBINED MODALITY

Indications

  • "Large lesions" with
    • bone or
    • nerve involvement

Management

  • Resection and post-op ChemoRT with ENI
  • or Definitive ChemoRT with ENI

NODE MANAGEMENT

  • "Advanced lesions"
  • poorly differentiated
  • recurrent lesions

ERYTHEMA of SKIN

Note

  • usually indicates dermal lymphatic involvement

Treatment

  • wide-field RT
  • consider surgical resection for good response to RT

RADIATION TREATMENT

lowerlip
Caption: 75 y.o. man with excision of middle lower lip. It was a melanoma with margin microscopically positive. It was thought that further surgery would remove most of the lower lip therefore, patient was offered radiotherapy. 30 Gy in 5 fractions was delivered twice a week, through the lateral fields.

Upper Lip

  • some institutions have used a "moustache field" for elective irradiation of the perifacial lymphatics for more advanced upper lip lesions.

LOCAL FIELD ONLY

  • primary tumor with 2 cm margin
  • Lead strips coated with wax or dental acrylic to protect the gingiva and oral mucosa.
  • no ENI

FIRST ECHELON NODES

  • submental nodes
  • submandibular nodes
  • subdigastric nodes

SECOND ECHELON NODES

  • mid- and low jugular nodes

FOLLOW-UP

Results of Treatment

T-stage Local recurrence
T1 7.4%
T2 12.7%
T3 24.8%
  • 20% of local and regional recurrence appear after 5 years
  • 5% develop new lip cancers.

Radiation Complications

  • atrophy of irradiated tissue
  • soft tissue necrosis
  • radiation caries (interstitial)
  • bone exposure (interstitial)
  • osteoradionecrosis (interstitial)
Bibliography
1. Frierson, H.F. and Cooper, P.H. Prognostic factors in squamous cel carcinoma of the lower ip. Hum. Pathol. 17: 346-354, 1986.
2. Cerezo L, Liu FF, Tsang R, Payne D. Squamous cell carcinoma of the lip: analysis of the Princess Margaret Hospital experience. Radiother Oncol. 1993 Aug;28(2):142-7.
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