Characteristics of non‐melanoma skin cancers of the cutaneous perioral and vermilion lip treated by Mohs micrographic surgery

Abstract

Background The lip and surrounding perioral region are susceptible to non‐melanoma skin cancer, but the distribution of basal cell and squamous cell carcinoma on the cutaneous and vermilion lips has not been fully elucidated. Objective To investigate the distribution of cutaneous and vermilion lip non‐melanoma skin cancer and to better describe risk factors, anatomic location, treatment characteristics and oncologic outcomes. Methods A retrospective comparative case series of patients undergoing Mohs micrographic surgery (MMS) at a single academic centre for lip and perioral basal cell and squamous cell carcinoma was performed over a 5‐year period. Demographics, medical comorbidities, surgical characteristics and recurrence status were extracted. Results Forty‐five vermilion and 116 cutaneous lip cancers were identified. Basal cell carcinoma (BCC) was more common in the cutaneous perioral region, while squamous cell carcinoma (SCC) was more common on the vermilion lip (P < 0.001). BCCs were more common on the upper vermilion lip and SCCs were more common on the lower vermilion lip (P < 0.001). Within the cutaneous perioral region, both BCCs and SCCs were more common on the upper perioral surface (P = 0.002). Male gender was associated with lower lip SCC (P = 0.015). Smoking, immunosuppression, anticoagulant use and hydrochlorothiazide use were not associated with cancer type or location. Recurrences were rare, but more common in vermilion lip cancers (6.6%) compared to perioral cutaneous cancers (0.8%). Outcomes for all groups were similar; BCCs of the vermilion lip had significantly greater mean MMS stages (P < 0.001) as did SCCs (P = 0.05). Conclusion Basal cell carcinoma is more commonly encountered on the cutaneous lip, whereas SCC is more common on the vermilion lip. Within the vermilion lip, BCC favours the upper lip, while SCC favours the lower lip. Within the cutaneous perioral region, both BCC and SCC favour the upper cutaneous tissue. Early stage lip cancers are curable by Mohs micrographic surgery with rare recurrences.

Educational Case: Basal Cell Carcinoma

“…While both BCC and SCC are most often found on sun-exposed areas, it is interesting to note that BCC is more common on the upper lip while SCC is more common on the lower lip. 4 Additionally, patients with a BCC or SCC may report easy bleeding of the skin lesion, whereas, this feature is rarely present in melanoma.…”

Une technique originale de réparation d’une double perte de substance de l’hémilèvre supérieure blanche

“…Les carcinomes basocellulaires (CBC) sont plus fréquemment localisés sur la lèvre supérieure blanche à la différence des carcinomes épidermoides (CE), plutôt situés sur la lèvre rouge inférieure [1]. Cette zone médiofaciale et périorificielle est considérée à haut risque de récidive pour les cancers cutanés non mélaniques, imposant des marges d'exérèse importantes pouvant parfois compliquer les reconstructions.…”

Outcomes of Upper Lip Mohs Surgery Repairs Using Standardized Scar Scales With Particular Emphasis on Vermillion Border Involvement

“…[1][2][3] The cutaneous and vermillion lips are common sites for photodamage, as well as exposure to carcinogens such as tobacco and alcohol, which makes them regular locations for the development of nonmelanomatous skin cancers (NMSC). [4][5][6][7][8] Standard treatment of NMSC in these locations is Mohs micrographic surgery (MMS) with reconstruction dependent on many different factors including defect location, depth, and size. 4,[8][9][10][11] The goals of reconstruction are maintaining normal anatomy and function and providing the highest possible aesthetic outcome.…”

“…[4][5][6][7][8] Standard treatment of NMSC in these locations is Mohs micrographic surgery (MMS) with reconstruction dependent on many different factors including defect location, depth, and size. 4,[8][9][10][11] The goals of reconstruction are maintaining normal anatomy and function and providing the highest possible aesthetic outcome. Depending on the nature of the defect and type of reconstruction, these tasks can be ambitious.…”