Case Study:
“Mr. Li, a 60-year-old long-term smoker, noticed a ‘recurrent small ulcer with scabbing’ on his lower lip over the past six months. Self-applied ointments were ineffective. The ulcer gradually enlarged, developing a cauliflower-like surface with mild pain and numbness. After examination, he was diagnosed with ‘lower lip squamous cell carcinoma.’ The treatment team formulated a plan involving surgical resection, radiotherapy, and lip reconstruction, successfully restoring his appearance and function.”

 

What is Lip Cancer?
Lip cancer (carcinoma of the lip) is a malignant tumor arising from the mucosa of the vermilion border. Over 90% are squamous cell carcinomas, while adenocarcinomas are rare. According to international cancer classification standards, lip cancer is distinct from oral cancer but is still categorized under head and neck tumors. It commonly occurs at the junction of the middle and outer third of the lower lip. The male-to-female incidence ratio is approximately 7:1, with peak prevalence between ages 50–70.

What Are the Symptoms of Lip Cancer?
Lip cancer progresses relatively slowly with late metastasis. However, delayed treatment can severely impact appearance and function. Common symptoms include:

• Early Stage:Small hard nodules, herpetic-like scabs, localized mucosal thickening, or leukoplakia, often mistaken for common ulcers or angular cheilitis.
• Progressive Stage:Ulcers expand into crater-like or cauliflower-shaped masses with bleeding, foul odor, and tingling, pain, or numbness around the lips or oral skin. Invasion of muscles or bones may cause difficulty opening the mouth or loose teeth.
• Late Stage:Metastasis to cervical lymph nodes or distant organs (lungs, liver, bones), posing life-threatening risks.

What Causes Lip Cancer?
The exact etiology remains unclear, but risk factors include:

• Chronic Irritation:Smoking, alcohol abuse, betel nut chewing, or foreign object biting causing repeated mucosal damage.
• UV Exposure:Outdoor workers with insufficient lip pigmentation face higher cancer risk due to prolonged sun exposure.
• Chemical Exposure:Long-term contact with substances like asphalt.
• Precancerous Lesions:Untreated leukoplakia, verrucous hyperplasia, or chronic ulcers.
• HPV Infection:Some cases correlate with human papillomavirus (HPV).

How is Lip Cancer Diagnosed?

• Physical examination of the lips and cervical lymph nodes, along with lifestyle inquiries (smoking, sun exposure).
• Biopsy of the lesion for pathological analysis to confirm cancer type and differentiation.
• CT/MRI to assess tumor depth and lymph node involvement.
• PET-CT to detect distant metastasis.
• TNM Staging:Based on tumor size (T), lymph node metastasis (N), and distant metastasis (M) to guide treatment planning.

What Are the Treatment Options for Lip Cancer?

• Surgery:Early cases undergo wide local excision (≥1 cm margins) with direct closure or local flaps. Advanced cases require neck lymph node dissection and possible partial jawbone resection, followed by reconstructive surgery using adjacent tissue or free flaps.
• Radiotherapy:External beam radiation for postoperative adjuvant therapy or inoperable patients, often using proton therapy for precision. Brachytherapy places radioactive sources directly on the lip to minimize tissue damage.
• Chemotherapy:For advanced or metastatic cases.
• Targeted & Immunotherapy:Agents targeting specific mutations (e.g., EGFR) or PD-1/PD-L1 inhibitors to improve survival in advanced stages.

Early detection is critical for effective treatment. If a lip ulcer persists for over 2 weeks, immediately contact ENT Head and Neck Surgery Centre for detailed evaluation by our ENT specialists (Tel: 3100 0555).

Source:

HK ENT Specialist Ltd.

ENT Head and Neck Surgery Centre

For ENT Services, Audiology & Speech Therapy,

Sleep Disordered Breathing Management,

Hearing Aid Prescription & Medical Cosmetic Services

https://www.hkentspecialist.hk