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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
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.
| Setting | Approach | Guideline |
|---|---|---|
| Early disease | Wedge or V excision with local flap reconstruction, or radiotherapy (external beam or brachytherapy) for commissure tumours or unfit patients. | NCCN Category 2A |
| Large, thick or node-positive disease | Resection with flap reconstruction, sentinel node biopsy or neck dissection, and postoperative radiotherapy; cisplatin for extranodal extension or positive margins. | NCCN Category 2A |
| Unresectable or metastatic | Cemiplimab as for cutaneous squamous cell carcinoma, or pembrolizumab-based treatment as for head and neck squamous cell carcinoma. | NCCN Category 2A |
| Prevention | Sun protection of the lips, smoking cessation, and treatment of actinic cheilitis. | not mapped |