Lip Cancer Research Articles

Diagnostic Accuracy of Screening of Lip and Oral Cavity Cancers or Potentially Malignant Disorders (PMD) by Frontline Workers: A Systematic Review and Meta-Analysis

Oral cancer screening strategies help reduce associated mortality and could be performed by a trained frontline health worker (FHW). The present review aims to assess the diagnostic accuracy of commonly used screening modalities for oral cancer performed by FHW in apparently healthy individuals. Electronic databases PubMed, Scopus, Embase, Cochrane Library, and Google Scholar, were searched. The review included studies conducted where apparently healthy adult individuals were screened by the FHW for cancer or PMD of the lip and oral cavity by any of the four commonly used techniques - Conventional Oral Examination (COE), toluidine blue staining (TBS), Oral Cytology (OC), and Chemiluminescent Illumination (CLI). A total of 2,413 potentially relevant articles were retrieved from the search, among which five studies for COE were included in the review. Four out of those five studies were done before the year 2000. None of the studies fitted the inclusion criteria for TBS, OC, and CLI. Pooled sensitivity of oral screening by COE performed by an FHW (n=5) was 88.8% (95% CI: 71.6-96.1), whereas pooled specificity was 91.9% (95% CI: 78.3-97.3). On subgroup analysis, the pooled sensitivity and specificity of studies where the prevalence of disease was <50% (n=4) was 84.5% (95% CI: 62.6 - 94.7) and 94.1% (95% CI: 82.2 - 98.2), respectively. COE by trained FHW had high pooled sensitivity and specificity for screening of oral cancer and PMDs. The screening techniques TBS, OC, and CLI, were not studied for mass screening by trained FHW. COE by trained FHW could be utilized for oral screening in limited-resource settings. However, the FHW should be sufficiently trained to get the desired benefits of early detection. Department of Health Research, Ministry of Health & Family Welfare, Government of India.

Risk of Non-cutaneous Cancers in Individuals with Basal Cell Carcinoma: A Population-based Cohort Study.

Evidence of the association between a personal history of basal cell carcinoma and the risk of non-cutaneous malignancies is conflicting. The aim of this study was to retrospectively clarify the risk of non-cutaneous cancers in individuals with basal cell carcinoma using nationwide Finnish registry data for 96,304 patients and 394,503 randomly selected population controls. In this study, individuals with basal cell carcinoma have an increased risk of other cancers (odds ratio (OR) 1.38; 95% confidence interval (95% CI) 1.36-1.40). The risk was most prominent for lip cancer (OR 5.29; 95% CI 4.50-6.21), mycosis fungoides (OR 3.13; 95% CI 2.31-4.23) and soft tissue cancers (OR 2.77; 95% CI 2.43-3.16). In age-adjusted model, men had higher risk of cancers overall compared with women (p < 0.05). In conclusion, the study found increased overall cancer risk among patients with basal cell carcinoma compared with randomly selected population controls.

Treatment outcomes of squamous cell carcinoma of the lip: A retrospective study.

Oral and lip cancer is the most common type of cancer among males in India. Early stage tumours of the lip (stages I and II) are treated with single modality treatment, using either radiotherapy [external beam radiotherapy (EBRT) or brachytherapy] or surgery. Locally advanced tumours (stages III and IVa) are treated with surgery followed by adjuvant treatment. The aim of the present study was to retrospectively evaluate the clinical profile and treatment outcomes of patients with squamous cell carcinoma of the lip who were treated with radical intent at the Regional Cancer Centre (Thiruvananthapuram, India). For this purpose, a total of 120 patients treated with radical radiotherapy (brachytherapy or EBRT) or surgery with or without adjuvant treatment between January 2010 and December 2016 were eligible for the analysis. Kaplan-Meier analysis was used to generate the survival outcomes. Univariate and multivariate analyses were performed to determine the impact of various patient- and tumour-related factors and treatment modality on outcomes. At a median follow-up time of 67.6 months, the disease-free survival (DFS) and overall survival (OS) rates at 4 years for the entire cohort were 69.1 and 86.7%, respectively. The 4-year OS rates for patients with stage I, II, III and IV disease were 88.9, 95.2, 86.8 and 75.3%, respectively, and the DFS rates were 83.6, 69.5, 78.8 and 42.9%, respectively. Primary tumour (P=0.025), nodal (P=0.005) and composite clinical (P=0.006) stage were found to be significant factors affecting DFS rates in the univariate analysis. However, only the nodal stage (P=0.005) was found to be a significant factor affecting DFS rates in the multivariate analysis. On the whole, the present study demonstrates that the outcomes of patients with lip carcinoma are favourable when treated at the early stages, and the results from this series are in line with those already published.

The Impact of the Danish National Smoking Ban From 2007 on the Incidence of Eight Smoking-related Diseases: A Nationwide Register-based Interrupted Time Series Analysis.

Previous research has documented the effect of comprehensive smoking bans on preventing various adverse health outcomes in the years post-ban. In 2007, Denmark implemented a national smoking ban that prohibited indoor smoking in workplaces and public settings, although only partial restrictions applied in specific premises such as small bars, one-person offices, and in psychiatric units. We tested the hypothesis that the implementation of the national smoking ban was associated with a decrease in incidence of smoking-related morbidity in the Danish population compared to the pre-ban period. Interrupted time series analyses including the entire Danish population (≥30 years) was conducted. Information of hospitalizations and cause-specific mortality due to acute myocardial infarction, heart failure, hemorrhagic stroke, ischemic stroke, chronic obstructive pulmonary disease, cancer in bronchus and lung, cancer in lip, mouth, oral cavity, and pharynx, and bladder cancer were obtained from population-based registers. Poisson regression models accounting for seasonal variations and secular trends quantified immediate changes in incidence rates occurring at the time of the smoking ban as well as changes in the post-ban trend compared to pre-ban levels. Overall, we observed no consistent declines in incidence of cardiovascular diseases, chronic obstructive pulmonary disease, or the specific types of cancer in the post-ban period compared with the pre-ban period. No consistent reduction in incidence of smoking-related diseases was observed after the smoking ban was introduced in Denmark. This probably reflects that the Danish smoking ban included several exemptions, resulting in a less comprehensive ban compared to those introduced in other countries. In this study, we found that the Danish national smoking ban from 2007 did not consistently reduced the incidence of eight smoking-related outcomes in the post-ban period compared to pre-ban levels. We argue that due to the exemptions in the smoking ban, which for example allowed smoking in specific premises of the care and nursing sector, in one-person offices, and small bars, the ban was not sufficiently comprehensive to influence smoking behavior and thereof the incidence of smoking-related morbidity. Our findings highlight the importance of introducing comprehensive legislative measures to yield largest health benefits at a population level.

Inferiorly based nasolabial flap for reconstruction of full-thickness medium-sized lower lip and commissural defects following ablative cancer surgery.

Information regarding the design and usage of inferiorly based nasolabial flap for lower lip and commissural defect reconstruction following ablative cancer surgery remains limited. This study aimed to provide our design and experiences for such reconstructive purpose. Patients with lower lip or oral commissural cancer who received curative surgery involving reconstruction with inferiorly based nasolabial flap were included. The demographic data and clinical outcomes of these patients were obtained by retrospective chart review. A total of eight patients were enrolled in this study. All patients received ablative surgery at the National Cheng Kung University Hospital during May 2019 to May 2021, with their surgical defects reconstructed with unilateral inferiorly based nasolabial flap successfully. Among the five patients with lower lip cancer, one had a limited area of necrosis at flap tip. Another patient had a small orocutaneous fistula that healed spontaneously. No trismus or oral incompetence was noted following recovery. For the three patients with commissural cancer, a second stage commisuroplasy was needed after primary reconstruction. One patient had limited wound dehiscence at mouth angle following surgery, resulting in mild oral incompetence. Although mild trismus was noted in these three commissural cancer patients, all patients resumed normal diet during follow-up. Inferiorly based nasolabial flap is an excellent local flap for lower lip reconstruction following cancer ablative surgery. It is also a viable option for reconstruction of oral commissural defects. Minimal donor side morbidity, good functional recovery, and esthetic outcomes can be achieved with meticulous flap design.

Awareness on ill effects of tobacco usage among tobacco users.

Tobacco use is reported to increase the chance of a person to get mouth, lip, and lung cancers, chronic bronchitis, cardiovascular diseases, etc. Tobacco-related deaths are reported to occur among almost six million individuals each year. The objective of the study is to assess awareness and perception on ill effects of tobacco usage among tobacco users in a dental institution. A self-administered survey form was distributed among 100 study participants. Google Forms were distributed in an online forum. The questions were related to awareness on ill effects of tobacco usage and perception regarding harmful effects of tobacco among tobacco users. Collected data were analyzed using statistical software. Among the 100 participants, 68% were males and 32% were females. 73% of the participants reported that they were aware that smoking causes lung disease. Graduated participants were more aware that reduced fertility and sexual impotence would develop among men due to tobacco use (Pearson Chi-square value - 29.380; P = 0.01). The present study suggested that even though most of the respondents had adequate knowledge about the effects of tobacco on general health, knowledge about the consequences of tobacco usage was still inadequate.

Laminin Immunostaining in Biopsies as a Useful Biomarker of Early Invasion in Actinic Cheilitis and Differential Diagnosis Between Actinic Cheilitis and Lip Cancer: New Insights

BackgroundSquamous cell carcinoma of the lip (LSCC) and oral cavity can be life-threatening if not diagnosed early. Precancerous lesions like actinic cheilitis (AC), can transform into LSCC. Laminin is a fundamental component for basement membrane (BM) and its integrity may prevent neoplastic invasion. Therefore, laminin immunostaining of BM may be useful in identifying early invasion in actinic cheilitis and thus in the differential diagnosis between AC and invasive LSCC or high-grade epithelial dysplasia (ED).Materials and methodsBiopsies from 46 patients with oral lesions were histologically analyzed and immunohistochemically stained for laminin-1.ResultsAC was diagnosed in 34 patients and LSCC in 12 patients, including 3 patients with AC and concomitant high-grade ED/in situ carcinoma. Laminin-1 immunostaining revealed intense and linear expression of the BM in AC with low-grade ED. Loss of laminin expression was observed in LSCC. Intracellular laminin expression in parabasal cells was noted in AC with high-grade ED/in situ carcinoma.ConclusionLaminin immunostaining could be useful in identifying AC cases suspected of early invasion. It could also contribute to the histopathological differential diagnosis between AC with low- and high-grade ED and between AC and invasive LSCC. The findings of this study provide new insights into the mechanism involved in the progression process of AC into LSCC, encouraging preclinical studies that may document the stochastic role of laminin in this process.

Contribution of Open Mouth Technique in 18F-FDG PET/CT Imaging in Patients with Malignant Lip Neoplasm.

Objectives: 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) plays an important role in evaluating head and neck cancers. However, localization and size evaluation in this region can be rough due to the multitude of the anatomic structures and physiologic uptakes. The aim of this study was to evaluate malignant lip lesions with the contribution of open mouth (OM) imaging technique at PET/CT.Methods:Fifty-six patients with malignant lip neoplasm underwent 18F-FDG PET/CT imaging. Each patient was imaged twice as whole-body PET/CT with routine closed mouth (CM) position; and OM head and neck image, standardized with a special device. Lesion maximum standard uptake value (SUVmax), localization, size, and involvement of lymph nodes were evaluated.Results:Lesion localization was correctly detected in 100% of the OM images. Lesion size in PET/CT was compared with clinical, radiological (magnetic resonance imaging and CT) and/or histopathological results and the size measurement was coherent at 47.1% and 95.6% for CM and OM images, respectively. It was observed that OM acquisition did not contribute additionally in detecting regional lymph node metastasis. Forty-one PET/CT scans with CT artifacts due to dental amalgams were evaluated and 46.3% dimensional and 53.7% localization errors were detected in the CM position. There was no statistically significant difference between OM and CM SUVmax (p>0.05).Conclusion:We concluded that additional OM head and neck imaging is useful and necessary to accurately determine the localization and size of the tumor, thus enhancing the value of PET/CT in staging, treatment response assessment, and restaging of patients with malignant lip cancer with or without dental amalgam

Stark differences in cancer epidemiological data between GLOBOCAN and GBD: Emphasis on oral cancer and wider implications.

SummaryBackgroundGLOBOCAN 2020 and Global Burden of Disease (GBD) 2019 are the two most established global online cancer databases. It is important to examine the differences between the two platforms, to attempt to explain these differences, and to appraise the quality of the data. There are stark differences for lip and oral cancers (LOC) and we attempt to explain these by detailed analysis of ten countries at the extremes of differences.MethodsAge-standardised incidence rates (ASIR) of LOC were obtained from GLOBOCAN 2020 and GBD 2019. Five countries with the greatest and smallest fold differences were selected. A systematic search of PubMed and Embase electronic databases was then performed to identify publications reporting the incidence of LOC in the selected countries between 2015 and 2022. Specifically, data sources of the articles were examined and evaluated.FindingsFor LOC, greatest differences were found in Papua New Guinea, Vietnam, China, Pakistan, and Indonesia (group A). In contrast, the United States of America (USA), Brazil, France, Germany, and India (group B) had the least differences between the two databases.InterpretationIt is not surprising that when GLOBOCAN and GBD could not obtain high-quality or accessible LOC data from national or local cancer registries, as in group A, discrepancies would be seen between the two online databases. In contrast, where only minor differences were seen between GLOBOCAN and GBD, as in group B, presumptively due to those countries having well-established cancer registries and healthcare administrative systems, the literature is more consistent. Moreover, many studies have grouped lip and oral cavity with pharynx and categorised outputs as “oral and oropharyngeal cancer” or “oral cavity and pharynx cancer”. Those categorisations lacked subsite accuracy and failed to realise that oral cancer and oropharyngeal cancer have completely different etiological factors, pathogeneses, prognosis, and treatment outcomes.FundingThis research received no specific grant or funding from any funding agency in the public, commercial, or not-for-profit sectors, and the authors received no financial support for the research, authorship, and/or publication of this article.

Treatment Interruption and Hospital Admission in Head and Neck Cancer Patients during Concurrent Chemoradiotherapy with or without Prophylactic Nasogastric Tube Feeding

Background: Worldwide, head and neck cancer (HNC) was the 6th most common cancer in 2020 in all ages and both sexes. In Bangladesh, lip and oral cavity cancer was the 2nd most common cancer in 2020. Up to 60% of HNC patients presents with locally advanced disease. Aim and Objective: To determine treatment Interruption and hospital admission in head and neck cancer patients during concurrent chemoradiotherapy with or without prophylactic nasogastric tube feeding. Materials and Method: A quasi-experimental study was performed in Radiation Oncology Department of National Institute of Cancer Research &amp; Hospital from 1st January 2020 to 31st December 2020. A total number of 68 Patients (34 patients in each arm) was included in this study according to inclusion and exclusion criteria by purposive Sampling technique. All patients in Arm A and Arm B were planned for total 66 Gray in 33 daily fractions, 2 Gray per fraction, 1 fraction per day, 5 fractions per week over 6½ weeks and inj. Cisplatin 40mg/m² was given intravenously 2 hours before radiotherapy on 1st day and then weekly. All the information’s were recorded in a pre-tested and semi-structured questionnaire. The analysis was done by using independent sample t test for continuous variables and chi-square test for categorical variables and data were presented in tables and graphs. Results: In this study, mean age was 52.5 ± 8.5 years and male: female ratio was 4.2: 1 among all patients. The Incidence of treatment interruption was significantly lower in Arm A compared with Arm B (29.4% in Arm A and 70.6% in Arm B, p-value &lt; 0.05). There were fewer patients who required hospitalization in Arm A (23.5% in Arm A and 55.9% in Arm B) and length of hospital stay was less too (5.3 ± 1.7 in Arm A and 10.0 ± 1.9 in Arm B, p value &lt;0.05). There were no significant differences in treatment response and toxicities between the two groups. Conclusion: Prophylactic nasogastric tube feeding at the beginning of CCRT in head and cancer patients is beneficial in terms of preventing treatment break and reducing hospital admission.

Oral Cancer Disparities in the Outer US-affiliated Pacific Islands.

Oral cancers in the US-affiliated Pacific Islands are poorly described despite disproportionately higher incidences in certain jurisdictions. This study attempts to better characterize the incidence, staging, and management of oral cancers in this region. Retrospective Epidemiological Study. A retrospective review was conducted across the US-affiliated Pacific Islands between 2007 and 2019. Patient data were obtained for individuals with primary head and neck cancers from the Pacific Regional Central Cancer Registry database. All cohorts were age-adjusted to the 2000 US Standard Population. Further analysis was performed on oral cavity cancers due to their clear predominance within the sample. A total of 585 patients with primary head and neck cancers were included. The average age was 54.5 ± 12.9 years, and most patients were male (76.8%). Oral cancer subsite analysis revealed the proportional incidence of buccal mucosa was higher in 5 of 9 jurisdictions when compared with the United States (p < 0.001). Tongue and lip cancers were not found to have significantly higher incidence proportions. Patients in the Pacific Islander group were less likely to be detected at earlier stages for cancers of the cheek and other mouth (p < 0.001), tongue (p < 0.001), and lips (p < 0.001) compared with the United States. Many Pacific Island populations are burdened with higher incidences of oral cancer with later staging. Further investigation is recommended to evaluate oral cancer-related outcomes and mortality in this region. 3 Laryngoscope, 133:1899-1905, 2023.

Trends in lip, oral cavity, and pharyngeal cancer mortality in the United States, 1999–2019

Changes in the epidemiology of lip, oral cavity, and pharyngeal (LOCP) cancers have been reported in the United States. This study aimed to examine recent trends in LOCP cancer mortality in the United States from 1999 to 2019. National mortality data were extracted from CDC WONDER, 1999-2019. International Classification of Diseases Codes, 10th Revision-C00-C14, were used to identify decedents of malignant neoplasms of the lip, oral cavity, and pharynx. LOCP cancer mortality trends were assessed by fitting a Joinpoint regression model overall, and by race/ethnicity, sex, age, and US Census Region. Annual Percentage Changes (APC) were derived to estimate variations in mortality trends over time. The age-adjusted mortality rate (AAMR) for LOCP cancers was 2.5 per 100 000 (95% CI: 2.5-2.5), equivalent to 180 532 deaths during 1999-2019. Overall mortality trends have stabilized since 2009 (APC=0.3; 95% CI: -0.1, 0.7), but an examination by subtype revealed rising mortality trends from cancers of the lip and oral cavity (APC=1.2; 95% CI: 0.7, 1.6) and pharynx (APC=3.2; 95% CI: 1.7, 4.8), and declining trends in malignancies of other and ill-defined areas of the lip, oral cavity, and pharynx (APC=-2.7; 95% CI: -3.4, -2.0). Trend variations were also noted by sex, age, US Census Region, and race/ethnicity. There are differential trends in mortality from LOCP cancers in the United States. Investigating the biological, individual, and contextual factors related to LOCP cancers would guide effective public health intervention efforts.

412.1: Lip Actinic Cheilitis and Its Relationship to Clinical Characteristics and Immunosuppression in Kidney Transplant Recipients

Introduction: Due to drug immunosuppression after kidney transplantation (KT), as well as factors such as chronic uremia and chronic sun exposure, Kidney Transplant Recipients (KTR) have a 46-fold increased incidence of Lip Cancer (LC). Because of the high prevalence of LC in KTR, there are concerns about its prevention, which can be accomplished by diagnosing Actinic Cheilitis (AQ) on lips, a potentially malignant oral lesion that can progress to LC. Aim: The purpose of this investigation was to see if there was a link between the clinical manifestations of AQ and the clinical profile of KTRs. Methods: Convenience sampling in a cross-sectional observational clinical study. An expert researcher completed the diagnosis and clinical staging of AQ in KTRs using Pointevin et al 2017 criteria and a clinical evaluation and photographic record of six different angulations of the lower lip were used to calibrate the researcher (Kappa intra-avaliador >0.8). Demographic data, time since KT, immunosuppressants, exposure to AQ risk factors such as alcoholism, smoking, chronic sun exposure, and exposure to volatile chemical agents, and history of positive serology for oncogenic viruses after KT were all obtained retrospectively from electronic medical records. For the association of variables, Chi-square and Macnemar tests were performed, with a significance value of (0.05). Results: The sample size was 48 (100%) KTR, with 29 people diagnosed with AQ (60.41 percent). Light-siknned KTR was linked with the most severe AQ staging in 9 subjects (18.75 percent; p=0.035). History of exposure to volatile chemical agents (16.33 percent; p=0.007), drunkenness (15.25 percent; p=0.008), and smoking (20.66 percent; p=0.05) were also risk factors for AQ. A history of prolonged sun exposure was linked to a higher severity of QA 22(45.83 percent; p<0.001). The prevalence of AQ was linked to the usage of tacrolimus 43 (89,58 percent; p<0.001) and azathioprine 11 (22,91 percent; p0.001). However, the use of Mycophenolate Mofetil was linked to the most severe cases of AQ in 7 patients (14.58 percent; p=0.05). Individuals who got sirolimus, on the other hand, showed less AQ expression, with 7 patients (14.58 percent; P=0.016) manifesting with lesser degrees. After TxR, positive Epstein-Barr Virus serology was linked to the existence of AQ 17 (35,41 percent; p=0.028). Conclusion: The presence and severity of AQ in KTR were linked to fair skin, chronic sun exposure, Epstein-Barr Virus infections, and the use of Mycophenolate Mofetil. Sirolimus appears to have a protective effect against the development of AQ. It is possible to select groups of patients at higher risk for AQ and, as a result, for LC using this clinical profile associated with the manifestation of AQ, allowing for prevention and early diagnosis. This study was approved by the Ethics and Research in Human Beings Committee under protocol CAAE12798019.3.0000.5417.

Epidemiological study on the lip and oral cavity cancer in Brazil: connecting science and clinical applicability.

SUMMARYOBJECTIVE:The aim of this study was to describe and discuss the epidemiological indicators of lip and oral cavity cancer in Brazil, in 2017, according to data from the Global Burden of Disease data.METHODS:This is a descriptive study reported according to STROBE guidelines. We identified epidemiological indicators using the Global Burden of Disease results tool. Mortality/incidence rates were described per 100,000 population. Global Burden of Disease 2017 reviews were completed using Python version 2.7, Stata version 13.1, and R version 3.3.RESULTS:In 2017, there were 5,237 deaths from the lip or oral cavity cancer in Brazil, most of them were males aged between 50 and 69 years (2,730 cases, which was equivalent to 52% of the universe of deaths resulting from this cause). Regarding the burden of lip and oral cavity cancer, per 100,000 Brazilians, we observed an incidence of 3.99, prevalence of 15.46, and mortality of 2.29 (with higher indicators in the South and Southeast regions of the country).CONCLUSIONS:Epidemiological indicators of lip and oral cavity cancer were higher in men, with higher mortality indicators in individuals aged 50–69 years, and higher rates (incidence, prevalence, and mortality) in the South and Southeast regions of Brazil. From 2002–2015, there was a reduction in mortality; however, in the period from 2015–2017, there was a resumption in the growth of this indicator.

Lip and Oral Cavity Cancer Burden and Related Risk Factors in China: Estimates and Forecasts from 1990 to 2049.

Simple SummaryChina’s lip and oral cavity cancer burden is rising. The elderly have a relatively heavy disease burden, mainly due to poor oral health awareness, the side effects of other diseases and delayed treatment. Moreover, the incidence of the elderly over 50 years old is predicted to increase further from 2020 to 2049 in China. Males have a heavier disease burden, mainly due to their smoking, drinking and work exposure. Early screening and health intervention policies incorporating key populations and risk factors may deserve the consideration of policy makers to reduce the disease burden.Lip and oral cavity cancer is a common malignancy faced by many developing countries, and the disease burden is high in China. This study explored this cancer burden and its risk factors using data from China in the GBD 2019, along with predicting the incidence trends in 2020–2049. Data on age-standardized rates (ASR), incidence, death and disability-adjusted life years (DALY), by sex, age and risk factors were collected from the Institute for Health Metrics and Evaluation (IHME). Joinpoint regression and Age–Period–Cohort (APC) models were selected to analyze the epidemic trend of this cancer in China, and descriptive analysis was used for the time trend and age distribution of risk factors. The Bayesian APC model was selected to foresee the incidence trend in 2020–2049. This cancer burden was found to be in an upward trend in China in 1990–2019. The upward trend was more pronounced among men than among women. These cancer deaths and DALYs are overwhelmingly attributable to smoking and drinking. On APC analysis, the younger generation in China demonstrated a lower cancer risk. In 2049, the incidence of this cancer is projected to be 3.99/100,000, 6.07/100,000, 7.37/100,000, 10.49/100,000, 14.82/100,000, 19.19/100,000, 20.71/100,000, 23.64/100,000, 16.42/100,000 and 9.91/100,000 among those aged 50–54, 55–59, 60–64, 65–69, 70–74, 75–79, 80–84, 85–89, 85–89 and over 95 years, respectively. Disease control policies and early screening should focus on men and the elderly and target different risk factors.

Assessment of Operative Time for Lip and Oral Cancers: A Tool to Improve Operative Room Efficiency.

Operation theatre (OT) time utilisation rates can be improved with an assessment of the procedure time that will result in effective scheduling of cases. Our study is the first of its kind to audit the amount of OT time required for a particular surgery in lip and oral cavity cancers, depending on the various components of this complex procedure. This prospective cross-sectional study, based on an operative room database of 323 OT sessions, was conducted in the Department of Surgical Oncology at a tertiary care centre on lip and oral cancer patients from January 1st, 2019 to December 31st, 2020. Various components of the surgery, like the primary site, operating surgeon, type of neck dissection, bone resection, and reconstructive procedure, were noted. The time of entry and exit of the patient from the OT was noted. Operative time and OT time utilisation rates were calculated. SPSS 21.0 statistical tool; Students 'T', ANOVA and Games-Howell tests were applied. In 323 OT sessions, while 303 surgeries were done for primary cases (93.8%), the remaining 20 cases were for recurrent cases (6.2%). Buccal mucosa and the floor of the mouth were the most and least common sites, respectively. The mean OT time was 212.42 ± 73.83min, the maximum being the primary at alveolus. The mean OT late start time was 70.03 ± 23.41min and the mean OT runover time was 37.62 ± 43.53min. The mean time varied significantly with the type of neck dissection, bone resection, and reconstructive surgery done and the operating surgeon. The mean OT time was highest for free flap reconstructive surgery (328.71 ± 62.02min), but it didn't vary with its type. Considering only the lip and oral cancer surgeries, the OT time utilisation rate was 57.1%. Assessment and quantification of the operative duration of lip and oral cancer surgeries will help in accurate prediction of surgical duration, better OT list planning, and thus improved OT time utilisation rate. Our research not only provides data on the historical mean of procedures, but it may also encourage other centres to adopt our quantitative approach to OT scheduling.

INTRAORAL AND LIP CANCER MORTALITY IN BRAZILIAN WOMEN: TIME TRENDS FROM 1980 TO 2018

<h3>Objectives</h3> To investigate the female mortality rate of intraoral and lip cancer in Brazil between 1980 and 2018 by anatomic location and Brazilian geographic regions. <h3>Study Design</h3> This was a descriptive ecological time series study. With secondary data based on official population estimates, the age-adjusted annual mortality rates were obtained by sex, anatomic location, and Brazilian geographic regions, and the annual percentage change was calculated. Data sets were analyzed using the Joinpoint Regression program. <h3>Results</h3> Of the 81,918 individuals who died from oral cancer during 1980 to 2018, 18,385 were women. The age-adjusted mortality rate for women was 0.47/100,000 in 1980 and 0.57/100,000 in 2018. A decrease in lip cancer mortality during 1980 to 2018 and intraoral cancer mortality in the 1980s was observed; however, in the last 2 decades, there were significant increases in female mortality, mainly due to cancer at the base of the tongue. Importantly, the northeast region presented a significant increase between 1993 and 2007 and the south and southeast regions have shown significant reductions since the 1990s. <h3>Conclusions</h3> There was a significant increase in the mortality rate due to oral cancer in Brazilian women during these 38 years.

INTRA-ORAL AND LOWER LIP SQUAMOUS CELL CARCINOMA: A COMPARATIVE ANALYSIS OF THE LYMPHOCYTIC HOST RESPONSE

Objectives To compare the effect of lymphocytic host response (LHR) in the prognosis of patients with tongue and/or floor of mouth squamous cell carcinoma (TFMSCC) and with lower lip squamous cell carcinoma (LLSCC). Study Design Records and slides from 179 patients were evaluated according to the histopathologic risk assessment (HRA) to LHR and submitted to bivariate (chi-square) and survival (Kaplan-Meier and log-rank) analyses. Results White male smokers at initial cTNM were the most affected, in both the TFMSCC and LLSCC. Tumors with strong LHR (61.9%) predominated and were classified as intermediate risk (56.9%) by AHR for TFMSCC and LLSCC. Associations between dense continuous band of LHR and smoking (P = .019), tumors located in the tongue or lower lip (P ≤ .0001), initial pTNM (P ≤ .0001), no recurrence (P = .021), moderately differentiated tumors (P = .001), and intermediate risk by AHR (P ≤ .0001) were observed. Patients with weak LHR had poor overall survival (OS) (P ≤ .0001) and disease-free survival (DFS) (P = .002). Conclusions For both lower lip cancer and intraoral cancer, the presence of a strong LHR demonstrates a favorable effect for OS and DFS and proved to be an important prognostic factor for these patients. To compare the effect of lymphocytic host response (LHR) in the prognosis of patients with tongue and/or floor of mouth squamous cell carcinoma (TFMSCC) and with lower lip squamous cell carcinoma (LLSCC). Records and slides from 179 patients were evaluated according to the histopathologic risk assessment (HRA) to LHR and submitted to bivariate (chi-square) and survival (Kaplan-Meier and log-rank) analyses. White male smokers at initial cTNM were the most affected, in both the TFMSCC and LLSCC. Tumors with strong LHR (61.9%) predominated and were classified as intermediate risk (56.9%) by AHR for TFMSCC and LLSCC. Associations between dense continuous band of LHR and smoking (P = .019), tumors located in the tongue or lower lip (P ≤ .0001), initial pTNM (P ≤ .0001), no recurrence (P = .021), moderately differentiated tumors (P = .001), and intermediate risk by AHR (P ≤ .0001) were observed. Patients with weak LHR had poor overall survival (OS) (P ≤ .0001) and disease-free survival (DFS) (P = .002). For both lower lip cancer and intraoral cancer, the presence of a strong LHR demonstrates a favorable effect for OS and DFS and proved to be an important prognostic factor for these patients.

COMPARISON OF FEATURES AND OUTCOMES OF VERMILION LIP SCC WITH ORAL AND HEAD AND NECK CUTANEOUS SCC

<h3>Objectives</h3> Comparing features and outcomes of patients with skin, lip, and oral squamous cell carcinoma (SCC) and evaluating restaging lip cancer as skin cancer. <h3>Study Design</h3> All patients surgically treated at our center for vermilion lip SCC, oral SCC, and cutaneous head and neck (HN) SCC between January 2011 and December 2019 were retrospectively reviewed. <h3>Results</h3> 79, 125, and 620 cases were respectively included. Lip and oral SCC were similar regarding tumor diameter (<i>P</i> < .001), depth of invasion (<i>P</i> < .001), surgical margins (<i>P</i> = .01), T stage (<i>P</i> < .001), N stage (<i>P</i> < .001), AJCC stage (<i>P</i> < .001), perineural invasion (<i>P</i> < .001), and vascular invasion (<i>P</i> < .001). In total, 31 lip SCC cases were restaged applying cutaneous HN SCC staging system criteria, with a shift from stages I/II and T1/2 to stages III and T3, respectively. In Kaplan-Meier curves, there was a good distinction among staging curves for oral SCC and cutaneous SCC but not for lip SCC, in both staging models. <h3>Conclusions</h3> There are more similarities between lip SCC and cutaneous HN SCC than oral SCC, although both staging systems failed to distinguish categories in Kaplan-Meier curves.

PHOTODYNAMIC THERAPY AS RESOURCE TO CONTROL OSTEORADIONECROSIS IN ALVEOLAR BONE: A CASE REPORT

A 38-year-old White male smoker for 20 years, diagnosed with lower lip cancer who underwent adjuvant radiotherapy (60 Gy) showed exposure and suppuration of the anterior region of the alveolar mandibular bone after 6 months after radiotherapy treatment. The size of the lesion was ±2 cm and caused fenestration of the buccal mucosa and bony with root exposition. A pulp sensitivity test of the teeth was performed and only teeth 25 and 26 were not vital. Based on radiographic and clinical features, the diagnosis was osteoradionecrosis. Antibiotic therapy (amoxicillin 500 mg), photodynamic therapy (PDT; 660 nm, 12 J/2 cm2, scan), and topical rifocin comprised the treatment established. Previous endodontic treatment was carried out. After 10 sessions of PDT associated with antibiotic therapy the suppuration was reduced, and the osteoradionecrosis was controlled. Rigorous follow-up has been recommended for the patient. PDT is a relevant therapy for the control of osteoradionecrosis. A 38-year-old White male smoker for 20 years, diagnosed with lower lip cancer who underwent adjuvant radiotherapy (60 Gy) showed exposure and suppuration of the anterior region of the alveolar mandibular bone after 6 months after radiotherapy treatment. The size of the lesion was ±2 cm and caused fenestration of the buccal mucosa and bony with root exposition. A pulp sensitivity test of the teeth was performed and only teeth 25 and 26 were not vital. Based on radiographic and clinical features, the diagnosis was osteoradionecrosis. Antibiotic therapy (amoxicillin 500 mg), photodynamic therapy (PDT; 660 nm, 12 J/2 cm2, scan), and topical rifocin comprised the treatment established. Previous endodontic treatment was carried out. After 10 sessions of PDT associated with antibiotic therapy the suppuration was reduced, and the osteoradionecrosis was controlled. Rigorous follow-up has been recommended for the patient. PDT is a relevant therapy for the control of osteoradionecrosis.