Site:
|
Lower
Lip
|
Histology:
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Squamous
Cell Carcinoma
|
Stage:
|
I-II
(T1-N0, T2-N0)
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- DIAGNOSTIC
EVALUATION
- EXAMINATION
UNDER ANESTHESIA AND BIOPSY
- DEFINITIVE
TREATMENT
- ADJUVANT
TREATMENT
- FOLLOW
UP
- BIBLIOGRAPHY
I.
DIAGNOSTIC EVALUATION:
Clinical Evaluation:
-
Complete history including
history of sun exposure and tobacco usage
-
Complete examination of
the head and neck.
Includes examination of the lip and skin of the head and neck, entire
oral cavity and oropharynx mucosa, indirect laryngoscopy of the larynx
and hypopharynx. Evidence of neural involvement of the lower lip musculature
(marginal nerve weakness) or hypesthesia of the mental nerve should be
documented. The examination includes an assessment of the status of the
mandible and the dentition, palpation of the neck bilaterally, recording
the location (Group or Level I - VI), size, mobility, and relationship
of any palpable node(s) to adjacent structures. The staging of the primary
and of the cervical lymph nodes must be documented.
Imaging Studies:
-
Panorex - Panoramic
View
Indicated if evidence of neural or bony involvement is present or when
appropriate to evaluate the patient's dentition.
-
PA and Lateral Chest
Radiograph
Indicated when general anesthesia is planned for removal in individuals
who smoke.
CT or MRI of the Neck
In the absence of palpable adenopathy in individuals with an obese or
muscular neck, who are at high risk of having metastases (i.e. age under
30, presence of perineural invasion).
Laboratory Tests
-
Preanesthesia laboratory
test (according to institutional guidelines)
Consultations
-
Radiation Therapy
In consideration for radiation treatment rather than surgery.
-
Dermatology
As needed in consideration for dermatologic treatment of malignant or
premalignant lesions or MOHS surgery for the primary lesion.
-
Internal Medicine, Cardiology,
or Anesthesiology.
As needed to evaluate existing conditions that may preclude or increase
the risk of general anesthesia.
Top
II.
EXAMINATION UNDER ANESTHESIA (OPTIONAL) AND BIOPSY
Examination under anesthesia is generally
not appropriate. Biopsy of the lesion can be done in the office with
local anesthesia.
Top
III.
DEFINITIVE TREATMENT:
Treatment of Primary Tumor
The choice of treatment depends upon the
anticipated functional and cosmetic outcome and the patient's general
condition
Surgery
If surgical excision is employed, the tumor
and adjacent premalignant tissue should be excised with an adequate margin
of normal tissue. Most early lip carcinomas can be excised under local
anesthesia.
Reconstruction:
Defects of the vermilion can be closed with
mucosal advancement.
Full Thickness Lip Lesion Defects Can Be Repaired By:
- Primary closure utilizing a V-lip or
W-lip excision is most appropriate if an acceptable functional and
cosmetic result is expected (resection of < 1/3 of the lower lip).
-
Local flap reconstruction
is appropriate for defects involving 1/3 to 2/3 of the lip (Abbe
flap, Estlander flap or Karapandzic flap).
Radiation
Radiation therapy as a definitive treatment is a satisfactory alternative
for cancer of the lower lip, particularly for patients where the anticipated
functional and cosmetic outcome is unsatisfactory with surgery, as well as
for those patients medically unfit to undergo surgery. Treatment by external
beam, brachytherapy or a combination of the two is employed as dictated by
the size and location of the tumor.
Chemotherapy
Not indicated.
Treatment of Neck
Treatment of the regional lymph
nodes is generally not indicated for stage I and II lesions with no evidence
of adenopathy on clinical and/or radiologic exam.
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IV.ADJUVANT
TREATMENT:
Preoperative
Not indicated.
Post-operative
Radiation should be utilized for microscopic positive margins only when
re-excision is not feasible, also for patients with extensive perineural
invasion or histologically positive nodes.
V.FOLLOW
UP:
-
Removal of sutures at 5-10
days.
Follow-up appointments are scheduled on an individual basis determined
by the risk of recurrence, to survey for the development of second primary
tumors, to deal with morbidity from treatment (i.e. speech and swallowing
problems as well as wound care), to provide social and psychological
support, and to deal with comorbidity not directly related to the cancer
itself.
-
After all treatment is
completed a general formula which is modified according to the individual
patient's characteristics is:
1st year post treatment: 1-3 months
2nd year post treatment: 2-4 months
3rd year post treatment: 3- 6 months
4th and 5th years: 4- 6 months
After 5 years: Every 12 months
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VI.BIBLIOGRAPHY:
Lore JM, Kaufman S, Grabau
JC, and Popovic DN. Surgical management and epidemiology of lip cancer.
Otolaryngologic Clinics of North America. 12:81-95, 1979.
Mehregan DA, Roenigk RK. Management
of superficial squamous cell carcinoma of the lip with Mohs micrographic
surgery. Cancer. 66:463-68, 1990.
Hosal IN, Önerci M, Kaya S and Turan E. Squamous
cell carcinoma of the lower lip. Am J Otolaryngol. 13(6):363-65, 1992.
Baker SR. Cancer of the lip.
In Cancer of the Head and Neck, 2nd ed., Churchill Livingston, New York,
383-413, 1989.
Bailey BJ. Management of carcinoma
of the lip. Laryngoscope. 87:250-60, 1977.
Stepnick DW. Cancer of the
lip. In Current Therapy in Otolaryngology - Head and Neck Surgery, 5th
ed., Mosby, St Louis, 257-61, 1994.
Jorgenson K, Elbrond O, Andersen
AP. Carcinoma of the lip: A series of 869 cases. Acta Radiol. 12:177,
1973.
Zitsch RP. Evaluation and
Surgical Therapy of tumors of the oral cavity: Lip tumors. In Comprehensive
Management of Head and Neck
Tumors, 2nd
ed., W.B. Saunders, Philadelphia, 673-685, 1999.
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