The treatment of carcinoma of the lowr lip.

Abstract

A variety of procedures may be effective in the treatment of carcinoma of the lower lip, but the chances of control and the esthetic and functional results vary depending on the circumstances of the case. The form of treatment to be preferred is thus determined by the size of the primary lesion, the presence or absence of concomitant metastases, the degree of differentiation of the tumor, and whether or not the patient has received previous unsuccessful treatment. The following considerations and conclusions are based on the study of 531 consecutive cases of previously untreated carcinoma of the lower lip admitted to the Ellis Fischel Cancer Hospital (Columbia, Mo.) from 1940 to 1953. A second group of 103 consecutive recurrences after treatment elsewhere is reported separately. Histology In all of the 531 patients the diagnosis of carcinoma was confirmed by biopsy. Many cases of extensive ulceration of the lower lip with the clinical appearance of cancer proved to be chronic inflammatory lesions associated with hyperkeratosis and are not reported here. The overwhelming majority of the tumors were well differentiated: 59 were of the so-called verrucous type and 336 were Grade I carcinomas. There were 103 cases classified as Grade II, and only 4 as Grade III. In 29 additional cases the diagnosis of carcinoma was made, but for various reasons grading could not be attempted. Treatment of the Primary Lesion In a great number of small carcinomas of the lower lip, a simple V-excision constitutes simultaneous biopsy and treatment; the procedure is expeditious and adequate provided that no more than one-fourth of the entire extent of the lip needs to be removed to assure a safe margin. Beyond this, surgical removal often requires a cheiloplasty, and the functional and esthetic results may be less satisfactory than those of radiotherapy. Resection of the primary lesion may be chosen, in spite of lesser esthetic result, in order to expedite the surgical treatment of a metastasis. In advanced lesions with jaw involvement or with a large defect, the surgeon may best plan his cosmetic attempts if he is allowed to manage the case from the beginning. Also, in cases of recurrence after various methods of treatment, surgery is often to be proposed. In the majority of lesions of moderate or large size, however, in the absence of concomitant metastases, radiotherapy, as directed by the circumstances of the case, is a much safer method and one which permits the most remarkable esthetic results. In a few of the cases reported here, surface radium was used for the treatment of the primary tumor. This approach is certainly effective, though painstaking, in small lesions. The procedure was discontinued sixteen years ago. We feel that roentgen therapy can well satisfy all of the indications of radiotherapy. The variations in technic of roentgen therapy are simply related to the size of the primary tumor.