Management of Lip Cancer

Abstract

The lips are the most common sub-site affected by cancers of the oral cavity. Given their location, these cancers are usually diagnosed early, but there are cases of aggressive and neglected cancers that can lead to significant morbidity and possible death. Squamous cell cancers represent the most common histology, and the lower lip is most commonly affected. Surgery, including Mohs’ micrographic excision, remains the mainstay of treatment although radiation therapy, both conventional external beam and brachytherapy, may play a role. Treatment of the regional lymphatics is controversial, and indications for elective treatment of the neck include histologic indicators of biologic aggressiveness, such as depth of invasion and peri-neural invasion. Reconstruction of the complex functional anatomy of the lip is closely linked to the surgical ablation of the cancer, and most commonly utilizes a variety of local flaps. Large tumors involving adjacent structures, such as the mandible, may require importing tissue via microvascular techniques. These vascularized flaps may be combined with local flaps for improved functional and esthetic outcomes.