Introduction:
Lip cancer is primarily a type of oral cancer, and most cancers in the lip usually develop in the squamous cells. They are classified as SCCS (squamous cell carcinoma), occurring in line with certain oral and facial structures and may involve the lips, tongue, cheeks, and even the throat. Lip cancer can usually be recognized faster compared to other slow-growing tumors of the head and neck. In most cases, it can be observed by the patients themselves. It has high survival rates if the disease is diagnosed early.
What Exactly Is Lip Cancer?
Lip cancer is a cancer that occurs in the lower and upper portions of the lips. Lip cancer can spread to other areas of the oral cavity in certain individuals. Lower lips are more typically impacted than upper lips. Cigarette smoking is a self-inflicted cause of lip cancer. Lip cancer can be treated with a modest surgical procedure. Prior planning of treatment and repair are required to improve the aesthetic look of the lips.
What Are the Clinical Signs of Lip Cancer?
Common signs and symptoms of lip cancer that can be recognized by the patient and should be immediately reported to the dental surgeon, maxillofacial surgeon, or physician include:
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Flat or slightly raised discoloration of the lip in the upper, lower, or commissure regions. These areas may turn whitish.
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A lip sore that is persistent and non-healing for many days to weeks.
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Tingling sensations are experienced or may be accompanied by a sensation of pain or lip numbness in the skin area surrounding the mouth or the oral cavity.
What Are the Risk Factors for Lip Cancer?
Lip cancers are classified among the most common and noticeable malignancies, unlike the other cancers or malignant lesions that show symptoms later, especially in the head-and-neck region. Squamous cell carcinoma (SCC) of the lips is the major constituent of nearly 90 % of malignant oral tumors. SCCs commonly affect the lip, which is the second most affected after the skin (skin cancers) in the head and neck region. The incidence of squamous cell lip carcinoma increases with age, with a general incidence in the seventh and eighth decades of life in the elderly population. The lower lip is affected more frequently (80 % to 95 %) in comparison to the upper lip (2 % to 12 %) or the commissure region of the lip (1 % to 15 %).
The pivotal risk factors recognized are in correlation to the prognosis impacted. These factors range from assessment of the size of the tumor, histopathological type or the tumor lesion grade, extent of perineural invasion, the metastatic potential or grading in the regional lymph nodes, and recurrence rates that depend upon the local risk factors that vary based on the individual affected. Detrimental habits, especially the use of tobacco products or tobacco smoking, people who consume excessive amounts of alcohol, that is, who suffer from chronic alcoholism, are at the highest risk of developing lip cancer.
Prolonged sun exposure aggravates the risk factors, and impacts host immunity in the development of this condition. The history of lip carcinomas that were originally detected majorly in the lower lip used to and is even now, in fact, a major risk factor for male smokers working in the open air, such as sailors, fishermen, or farmers who are exposed to the ultraviolet radiation of the sun that aggravates the pathogenesis.
Immunocompromised or immunosuppressive patients in the aged groups are also at an increased risk. However, research indicates that, especially after an organ transplant, the incidence or occurrence rates are more in these individuals with increased risk.
Clinical research emphasizes the pathogenetic role of certain viral factors of genetic origin; a few implicated viruses like the HPV (human papillomavirus) and HSV (herpes simplex virus) viruses, for example, the HPV16, HPV24, HSV1, HSV2 virus, etc. Therefore, evidence of the link between the association of HSV2 virus in these individuals post-exposure to ultraviolet rays or other factors would play a significant role in the increased risk of oral tumors.
How Is Lip Cancer Diagnosed?
Lip cancer is diagnosed using the following tests and procedures:
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Physical Examination: During a physical exam, the physician will look for indications of cancer in the lips, mouth, face, and neck. The doctor will inquire about the signs and indicators.
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Biopsy: Taking a tissue sample for testing. The physician will take a small sample of tissue for laboratory testing during a biopsy. A pathologist (a clinician who analyzes bodily tissue) can evaluate whether cancer is present, the type of cancer, and the amount of aggressiveness present in cancer cells in the laboratory.
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Imaging Examinations: Imaging tests could be conducted to see if the cancer has progressed beyond the lip. Examples of imaging examinations include computerized tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography.
What Is the Treatment for Lip Cancer?
Treatment options include resection of the tumor by surgery, chemotherapy, and radiation therapy which are not always mandatory and may be necessitated only when it is of chronic nature, depending on the depth of tumor lesions. Surgical removal of the tumors of the lip may be indicated by the maxillofacial surgeon at an advanced stage when the lesions are chronic or untreated and do not pose clinical issues as such during the reconstruction of the lip in comparison to other common tumors of the head and neck.
A surgeon eliminates the malignant tissue as well as a very tiny portion of healthy tissue surrounding the tumor (called a margin) in early-stage malignancies. Sutures are used to seal the incision. Sutures inside the mouth and on the lip will disintegrate over time. On the skin, non-dissolvable sutures are employed. Lip cancer can benefit from micrographic surgery (also known as Mohs surgery). The malignancy is removed in thin slices during this form of surgery.
Before taking another slice, the medical team examines each slice under a microscope. They come to a halt when they come across a cancer-free slice. Examining each slice allows the doctor to remove as little tissue as feasible. This method allows us to keep the structure of the lips while reducing the possibility of speech issues.
After surgical resection, the strategy is the lip reconstruction that requires correction of any functional or esthetic defects, requiring the oral surgeon or the operator to preserve as much remnant unaffected natural tissue as possible to retain and restore the lip's natural form and function.
How Is the Surgical Reconstruction of Lips Done?
Surgical lip reconstruction is a significant relief to the patient so that the lip's basic role of feeding, speaking, or showing facial expressions is restored to normalcy. During reconstruction, the oral surgeon considers all three layers involved - skin, muscle, and mucosa. Reconstructive surgeries are indeed the major clinical challenges for the operator.
In the case of lip carcinomas, the Gillies fan flap is a commonly recommended procedure during reconstruction that carries the commissure along with the lower lateral lip inward for the lower-lip defects that are medially located. This may result in the commissure that is distorted with the shortening of the lower lip. Surgeons in the recreation of the border between the vermilion lip borders and the red and white portions of the affected lip also recommend buccal advancement flaps.
Conclusion:
Lip cancer has a good prognosis, and patients will have a healthy recovery in the long term, especially when detected and treated in the initial stages. Surgical reconstruction of the lips by the oral surgeon for aggressive or extensive cases of lip cancer is a viable option for esthetic restoration of lip form and function in the affected individual.
