Squamous Cell Carcinoma of the Lower Lip; Is Prophylactic Neck Dissection Required and Evaluating Predictive Factors

Secaattin Gülşen; Saffet Ulutaş

doi:10.5152/EurJTher.2019.18040

Authors

Secaattin Gülşen Clinic of Ear Nose Throat, Private Hatem Hospital, Gaziantep https://orcid.org/0000-0003-0687-6057
Saffet Ulutaş Clinic of Plastic Reconstructive and Aesthetic Surgery, Deva Hospital, Gaziantep https://orcid.org/0000-0002-8214-4002

DOI:

https://doi.org/10.5152/EurJTher.2019.18040

Keywords:

Carcinoma, lip reconstruction, lower lip scc, prophylactic neck dissection

Abstract

Objective: This research introduces a series of 87 cases of squamous cell carcinoma of the lower lip. We aim to evaluate the efficacy of prophylactic neck dissection and assess determinative factors for local recurrence and regional metastasis in lower lip carcinomas.
Methods: Medical records of 87 consecutive patients who were diagnosed with squamous cell carcinoma (SCC) of the lower lip were retrospectively analyzed for specific parameters at the Ear Nose Throat (ENT) and Plastic & Reconstructive Surgery clinic at the Dr. Ersin Arslan Training and Research Hospital and the ENT clinic at the Gaziantep University School of Medicine between 2011 and 2017. Patients who had been previously operated upon in other centers were excluded from the study. Tumor excision with safe margins confirmed by frozen sections and supraomohyoid neck dissection was performed on all the patients involved in this study. The minimum follow-up was 12 months for all patients. The median follow-up was 23 months (ranging from 12 to 72 months).
Results: The data analysis indicated that local recurrence was significantly related to the tumor size, depth, and proximity of the tumor to surgical margins. Local recurrence was detected in 8 (9.1%) of 87 patients. Time from onset of disease to the diagnosis, size of the tumor, and proximity of the tumor to the lip commissure play an important role in the spread regional metastasis. Overall the regional metastasis rate was found to be 22.9% (20 of the 87 patients). The occult metastasis rate was found to be 9.1% (8 of the 87 patients). The overall survival rate of patients with lower lip carcinoma, who underwent a supraomohyoid neck dissection and excision of the tumor was 96.5% (84 of the 87 patients).
Conclusion: Although lower lip cancers generally have a good prognosis after a proper surgical intervention, it can be life-threatening in case of neck metastasis or local recurrence. Certain factors, such as tumor size, location, and time interval between onset of disease and diagnosis are influencing the prognosis. Prophylactic neck dissection should be performed when the risk of cervical lymph node metastases is high in patients, especially to cases in which the tumor is close to the commissure. Early detection, prophylactic neck dissection, and follow-up with frequent intervals are essential for a good prognosis.

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