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Squamous Cell Carcinoma of Lip

Article
Skin Care
Diseases & Conditions
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Contributed byLester Fahrner, MD+1 moreDec 16, 2021

What are the other Names for this Condition? (Also known as/Synonyms)

  • Lip Cancer - Squamous Cell Type
  • SCC of Lip

What is Squamous Cell Carcinoma of Lip? (Definition/Background Information)

  • Squamous Cell Carcinoma (SCC) of Lip is a common malignant tumor of the skin that typically affects elderly men and women. It is more aggressive than conventional squamous cell carcinoma affecting other body regions
  • Prolonged exposure to the sun’s ultraviolet rays may result in damage of skin DNA causing the condition. Other factors that may influence its development include skin tanning, radiation treatment for other reasons, previous burn injuries, smoking, and exposure to coal tar and arsenic
  • Cutaneous squamous cell carcinomas may appear as slow-growing skin lesions, commonly on the sun-exposed areas, such as the face, neck, hands, and even on the chest. The lesions may ulcerate and cause scarring of skin
  • The treatment of choice is a surgical excision with clear margins. If needed, surgery can be  followed by radiation therapy or chemotherapy, as decided by the healthcare provider. In majority of the cases, the prognosis is good with appropriate treatment
  • Nevertheless, the prognosis of Squamous Cell Carcinoma of Lip depends upon many factors including the stage of the tumor and health status of the affected individual. There is a possibility of local or regional metastasis, which can involve the lymph nodes. This may dictate the course of the condition

Who gets Squamous Cell Carcinoma of Lip? (Age and Sex Distribution)

  • Squamous Cell Carcinoma of Lip generally affects elderly or older adults; some cases rarely develop in children too
  • It can occur in both males and females
  • SCC is generally prevalent worldwide, though dark-skinned individuals (Asians and Africans) are affected less than lighter-skinned individuals (Europeans and Americans)

What are the Risk Factors for Squamous Cell Carcinoma of Lip? (Predisposing Factors)

The risk factors for Squamous Cell Carcinoma of Lip include:

  • Exposure to intense sun for long periods during the course of work or due to regular participation in outdoor sports activities
  • Frequent use of tanning beds, tanning parlors
  • People living in geographical regions where hot-dry, desert-like climatic conditions prevail
  • Radiation therapy
  • Previous burn sites
  • Arsenic exposure
  • Coal tar exposure
  • Smoking and chewing of tobacco are strong risk factors for this type of lip cancer
  • Lichen planus of the lip increases the risk for Squamous Cell Carcinoma of the Lip
  • Individuals with weak immune system, which could be due to cancer treatment or AIDS, or those on immunosuppressant drugs after receiving an organ transplant
  • Those with sensitive skin, who are easily sunburned
  • Caucasians are more vulnerable compared to other dark-skinned individuals

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Squamous Cell Carcinoma of Lip? (Etiology)

  • Squamous Cell Carcinoma of Lip is caused when skin cells (the keratinocytes that form the epidermis) are burnt or damaged from prolonged (frequently severe) exposure to the ultraviolet component of the sun over many decades
  • The source of UV may be from lamps and other such devices, apart from the sun, and their effect on the skin may cumulatively add-up
  • Smoking and tobacco chewing may strongly influence development of SCC of Lip
  • Sometimes, individuals working in certain industries may be exposed to chemicals or X-rays for a long duration. This may also contribute to its formation
  • Scientific research has indicated that the human papillomavirus along with other risk factors, such as sun-exposure, skin color, and an advancing age, seem to greatly multiply the chances of an individual being affected by oral SCC. Nevertheless, the reason behind how the virus is responsible for influencing the condition’s development is not well-established

What are the Signs and Symptoms of Squamous Cell Carcinoma of Lip?

The signs and symptoms of Squamous Cell Carcinoma of Lip include:

  • In majority of the cases, the condition is asymptomatic and does not present any signs or symptoms (during the initial period)
  • Generally, squamous cell carcinomas of skin are slow-growing tumors; though SCC of Lip is an aggressive form of cancer
  • These lesions are observed on the lower lip in a majority of the cases. The oral cavity may also be affected
  • The tumor may be single; though, it is not uncommon to find multiple tumors in an individual
  • The skin lesions may appear as crusted ulcer, plaques, and nodules
  • It may ulcerate and bleed. Occasionally, after the ulcer heals, it may become ulcerated again
  • The size of the lesions range from 1-10 cm; average size is usually less than 3 cm
  • In some cases, the carcinoma may appear more pigmented than surrounding skin
  • Individuals with immunocompromised states have more aggressive tumors

How is Squamous Cell Carcinoma of Lip Diagnosed?

A diagnosis of Squamous Cell Carcinoma of Lip is made by the following tests and exams:

  • Complete physical examination with detailed medical history evaluation
  • Examination by a dermatologist using a dermoscopy, a special device to examine the skin
  • Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation

Although the above modalities can be used to make an initial diagnosis, a tissue biopsy of the tumor is necessary to make a definitive diagnosis to begin treatment.

Tissue biopsy:

  • A tissue biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
  • Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
  • Sometimes, the pathologist may perform special studies, which may include immunohistochemical stains, molecular testing, and very rarely, electron microscopic studies to assist in the diagnosis

In case of metastatic SCC, the following diagnostic procedures can be used to procure the tissue sample:

  • Fine needle aspiration (FNA) biopsy of the tumor: A FNA biopsy may not be helpful, because one may not be able to visualize the different morphological areas of the tumor. Hence, a FNA biopsy as a diagnostic tool has certain limitations, and an open surgical biopsy is preferred
  • Core biopsy or open biopsy of the tumor

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Squamous Cell Carcinoma of Lip?

The possible complications due to Squamous Cell Carcinoma of Lip include:

  • Discomfort, irritability of the affected skin
  • Permanent scarring might occur with SCC and restorative surgery may be required to restore the functional and cosmetic aspects of the lip and surrounding structures
  • They can metastasize to the lymph nodes; SCC of Lip has a higher rate of metastasis than most other locations
  • Tumors that invade into nerves (perineurial invasion) have higher chances of recurrence and metastasis
  • Tumors that are over 2 cm in size have a higher incidence of recurrence and metastasis than tumors that are less than 2 cm in size
  • Severe emotional and psychological stress
  • Complications that arise from cancer therapy (such as due to chemotherapy or radiation therapy)

How is Squamous Cell Carcinoma of Lip Treated?

Early diagnosis and treatment of Squamous Cell Carcinoma of Lip is important to avoid complications such as metastasis to other regions. The treatment measures may include:

  • In most cases, surgical removal is the initial treatment option. This can be done by either of the two most common approaches:
    • A wide surgical excision and removal of the entire tumor can be done. This is undertaken under general anesthesia, with 1-2 cm of normal tissue on either side of the carcinoma removed, and the defect sutured closed. The excised specimen may be examined with frozen sections by a pathologist to check for completeness. The final specimen will also be examined with standard pathology sections and slides
    • Mohs micrographic surgery: With this technique, smaller specimens are taken, and the margins examined between stages to check for complete tumor removal. If SCC of the Lip is still present, as many subsequent layers (as necessary) are removed to get clear margins
  • Once the local Squamous Cell Carcinoma of the Lip is completely removed, radiation therapy and/or chemotherapy may be given (if required) to obtain cure or decrease recurrence risk
  • If the tumor has metastasized (in rare cases), then a combination of chemotherapy, radiation therapy, and invasive procedures may be used to treat the tumor
  • Targeted therapy medications are generally used for locally-infiltrated or metastatic SCCs. This therapy destroys the tumor cells by acting against the proteins that are responsible for tumor growth. These can be given before surgical removal to decrease the tumor size, if the lesion is so large that surgery will be complex
  • Reconstructive surgery may be necessary after cancer therapy
  • Use of photodynamic light or laser therapy: Light destroys the damaged cells after they are treated with a special medical application
  • Cryotherapy: Controlled use of liquid nitrogen, to force spontaneous peeling and removal of skin
  • Large tumors after complete skin excision may need skin grafting or flap surgery
  • Post-operative care is important: One must maintain minimum activity levels until the surgical wound heals

Follow-up care with regular screening and check-ups are important and highly-recommended.

How can Squamous Cell Carcinoma of Lip be Prevented?

A few methods to prevent Squamous Cell Carcinoma of Lip include:

  • Avoid prolonged and chronic exposure to the sun. If this is unavoidable (like due to an occupational requirement), then take safety steps to reduce exposure to UV rays by using sunscreens with high sun-protection factor, wide-brimmed hats, and protective clothing
  • Be aware of the hazards of prolonged sun exposure and take steps to protect yourself. Plan and modify your work tasks to stay out of the sun during the period, when it is at its most intense
  • Stop smoking and chewing of tobacco products
  • Avoid excessive sunbathing (particularly if you are fair-skinned), use of tanning beds, sun lamps, and chemical agents, that accelerate sun tanning
  • Individuals who are regularly exposed to the sun or work under the sun, should get their skin periodically examined by a physician. This is especially important if they suspect or notice any skin changes

Regular medical screening at periodic intervals with blood tests, scans, and physical examinations are mandatory, due to its high metastasizing potential and possibility of recurrence. Often several years of active vigilance is necessary.

What is the Prognosis of Squamous Cell Carcinoma of Lip? (Outcomes/Resolutions)

In general, Squamous Cell Carcinoma of Lip is an aggressive form of cancer. If metastasis (such as to the local lymph nodes) is observed, then the prognosis may be guarded or unpredictable.

  • Tumors in their early stage with complete excisional treatment typically have good prognosis
  • In cases of metastasis, its prognosis depends upon a set of several factors that include:
    • Stage of tumor: With lower-stage tumors, when the tumor is confined to site of origin, the prognosis is usually excellent with appropriate therapy. In higher-stage tumors, such as tumors with metastasis, the prognosis is poor
    • The surgical resectability of the tumor (meaning if the tumor can be removed completely)
    • Overall health of the individual: Individuals with overall excellent health have better prognosis compared to those with poor health
    • Age of the individual: Older individuals generally have poorer prognosis than younger individuals
    • Whether the tumor is occurring for the first time, or is a recurrent tumor. Recurring tumors have a poorer prognosis compared to tumors that do not recur
    • Response to treatment: Tumors that respond to treatment have better prognosis compared to tumors that do not respond so well to treatment

Additional and Relevant Useful Information for Squamous Cell Carcinoma of Lip:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/diseases-conditions/cancer/

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On the Article

Krish Tangella MD, MBA picture
Approved by

Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team
Lester Fahrner, MD picture
Reviewed by

Lester Fahrner, MD

Chief Medical Officer, DoveMed Team

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