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Cancer of the lip is really a skin cancer of the sun-exposed lower lip, usually found early because it can be seen. A small operation or radiotherapy cures most people, and reconstruction keeps the mouth working.
Lip cancer is squamous cell carcinoma of the vermilion, the red part of the lip, and the great majority arise on the lower lip, which faces the sun, in fair-skinned men who work outdoors or smoke, often from a precursor patch of actinic cheilitis. Upper lip tumours are more often basal cell carcinomas spreading from the skin. Because the eighth edition of the staging system moved vermilion lip cancer into the skin cancer chapter, only cancer of the inner mucosal lip is now staged with the oral cavity, though lip cancer is still treated by head and neck teams.
Most tumours are small when found and are cured by wedge excision, closed directly or, for larger defects, with Abbe, Estlander or Karapandzic flaps that keep the mouth competent and mobile. Radiotherapy, by external beam or brachytherapy, is an equally effective alternative, chosen for tumours at the commissure or in patients unfit for surgery. Nodal spread is uncommon in small tumours, so the neck is observed or staged with sentinel node biopsy and dissected only when nodes are found or the primary is large, thick or has perineural invasion.
Advanced tumours invading the jaw or with nodal spread are treated with resection, neck dissection and postoperative radiotherapy, with cisplatin for extranodal extension or positive margins, and unresectable or metastatic disease is treated as cutaneous squamous cell carcinoma with cemiplimab or as head and neck squamous cell carcinoma with pembrolizumab. Sun protection and smoking cessation prevent most cases, and treating actinic cheilitis prevents progression.
Mostly squamous cell carcinoma of the lower lip in fair-skinned outdoor workers and smokers; it is caught early because it is visible, and excision or radiotherapy cures the great majority.
Site decides cause and behaviour: HPV drives oropharyngeal cancer, EBV drives nasopharyngeal cancer, tobacco drives oral and laryngeal cancer; all drain into the neck node levels that surgeons and radiotherapists map.
Same organ: Acinic cell carcinoma of the salivary glands, Carcinoma ex pleomorphic adenoma, Multiple endocrine neoplasia type 1 (MEN1), Multiple endocrine neoplasia type 2 (MEN2A and MEN2B), Hyperparathyroidism-jaw tumour syndrome (CDC73-related parathyroid carcinoma), Oropharyngeal cancer (tonsil and base of tongue), Laryngeal and hypopharyngeal cancer, Oral cavity cancer (mouth and tongue), Head and neck squamous cell carcinoma, Nasopharyngeal carcinoma, Salivary gland cancers, Papillary thyroid cancer, Follicular thyroid cancer, Medullary thyroid cancer, Anaplastic thyroid cancer, Thyroid cancer, Nasal cavity and paranasal sinus cancers (including esthesioneuroblastoma), NUT carcinoma (midline carcinoma with NUTM1 rearrangement), Parathyroid carcinoma, Multiple endocrine neoplasia syndromes (MEN1, MEN2, MEN4), HPV-positive oropharyngeal cancer, HPV-negative head and neck squamous cell carcinoma (including HPV-negative oropharyngeal cancer), Recurrent or metastatic head and neck squamous cell carcinoma, Hypopharyngeal cancer, Adenoid cystic carcinoma, Salivary duct carcinoma, Mucoepidermoid carcinoma, Oral tongue and floor of mouth cancer, Buccal mucosa and gingivobuccal cancer (oral cancer in India), Locoregionally advanced nasopharyngeal carcinoma (stage III to IVA), Recurrent and metastatic nasopharyngeal carcinoma, Esthesioneuroblastoma (olfactory neuroblastoma), Sinonasal undifferentiated carcinoma (SNUC) and SWI/SNF-deficient sinonasal carcinoma
Wedge or V excision with local flap reconstruction, or radiotherapy (external beam or brachytherapy) for commissure tumours or unfit patients.
Resection with flap reconstruction, sentinel node biopsy or neck dissection, and postoperative radiotherapy; cisplatin for extranodal extension or positive margins.
Cemiplimab as for cutaneous squamous cell carcinoma, or pembrolizumab-based treatment as for head and neck squamous cell carcinoma.
Sun protection of the lips, smoking cessation, and treatment of actinic cheilitis.
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Patients with head and neck squamous cell cancer that has recurred or spread should be treated first with pembrolizumab: alone if their tumour is strongly PD-L1 positive and they can wait for a slower response, or with chemotherapy if the tumour is bulky or PD-L1 low. Cetuximab-based chemotherapy is no longer the default. Long-term follow-up shows a small but real group of patients alive at four to five years, which was almost unheard of before.
PD-1 blockade is the first-line systemic treatment for advanced cutaneous squamous cell carcinoma, including on the lip, and cemiplimab has since moved into neoadjuvant and adjuvant use.
Cetuximab-radiotherapy is the standard for patients who cannot receive cisplatin; head-to-head trials in HPV-positive disease (RTOG 1016, De-ESCALaTE) later showed it inferior to cisplatin where cisplatin is possible.
Cisplatin chemoradiation after surgery is standard for extranodal extension or involved margins; radiotherapy alone suffices for other adverse features.
Query for this cancer: (TITLE:"Lip cancer" OR ABSTRACT:"Lip cancer" OR TITLE:"Lower lip squamous cell carcinoma" OR ABSTRACT:"Lower lip squamous cell carcinoma" OR TITLE:"Cancer of the lip vermilion" OR ABSTRACT:"Cancer of the lip vermilion") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Lip cancer, not a curated reading list.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
Immunotherapy can attack hormone-producing glands: most often the thyroid (usually ending in an under-active thyroid needing lifelong tablets), and less often the pituitary (hypophysitis) or adrenal glands, which can be life-threatening if missed.
The leukaemia risk after chemotherapy was described in the era of mustards and etoposide, and it did not stay there. Platinum drugs carry it, PARP inhibitors raise it about two and a half times against placebo, and lenalidomide with oral melphalan raises it nearly fivefold against melphalan alone. The absolute numbers are small, but the choice of partner drug is sometimes a real decision.
See all on the product pages:CemiplimabCisplatinPembrolizumab·Printable cards in the navigator
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