Lip (Cancer and Reconstruction)

10.1055/b-0034-97696

Tracy S. Kadkhodayan & Terence M. Myckatyn

A 2.3 × 2.5-cm partial-thickness defect of central upper lip involving mucosa, vermilion, and cutaneous lip.
- Involves multiple critical structures: Cupid′s bow, philtral dimple, and philtral columns bilaterally.
Orbicularis oris muscle intact.

History of sun exposure.
Personal and family history of skin cancer.
Genetic conditions: Xeroderma pigmentosum, Gorlin (nevoid basal cell) syndrome, albinism.
History of radiation therapy
Organ transplantation: Squamous cell carcinoma is the most common cancer in solid organ transplant recipients

If patient presents initially without resection, a biopsy should be performed at the time of evaluation to establish a diagnosis.
- Full-thickness incisional versus excisional biopsies may be performed. Avoid shave biopsies.

Consider Mohs surgery, if available.
- Allows examination of ~ 100% of surgical margins; highest cure rates.
- Board examiner may require that you excise this yourself.

Basal cell carcinoma:

Standard margin is 2-5 mm
Larger margin for high risk types (poorly defined borders, recurrent, perineural invasion, aggressive growth pattern)
Radiation therapy can be used for non-surgical candidates

Standard margin recommendations for different types of skin cancer
Basal Cell Cancer	Squamous Cell Cancer	Melanoma (Breslow thickness)
Standard margin: 2–5 mm	< 2 cm, well differentiated: 4 mm	In situ: 5 mm
Margin for aggressive subtypes: 7 mm	> 2 cm, invasive to fat, high-risk location: 6 mm	< 1 mm: 1 cm
		1 to 2cm
		> 2 mm: 2 cm

Squamous cell carcinoma: Most common type in lip, > 90% occur on lower lip.
- 4 mm margins for low risk lesions: Well/moderately differentiated, well defined borders, trunk/extremity lesions > 2 cm.
- 6 mm margins for high risk lesions: Poorly differentiated, poorly defined borders, perineural/vascular involvement, Clark level IV or V, recurrent, high risk locations (mask area of face, hands/feet, genitalia)
- Enlarged lymph nodes should be evaluated for metastases with FNA or core needle biopsy.
- Radiation therapy can be used for non-surgical candidates
Melanoma: Margins determined by Breslow thickness.
- In situ: 5 mm.
- < 1 mm: 1-2 cm
- 1 to 2 cm.
- 2.1 to 4 mm: 2 cm.
- > 2 cm: 2 cm.
- Stage Ib (0.76-1 mm thick with ulceration or mitotic rate > = 1 per mm2) or stage II melanoma (> 1 mm thick) may require sentinel lymph node biopsy (ENT or surgical oncology consultation). If lymph nodes are positive, neck dissection is performed.
- Stage III melanoma (positive lymph nodes) may require interferon (medical oncology consultation).