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Cutaneous Squamous Cell Carcinoma of the External Lip: 40-Year Trends

By: Noelle Cutter, PhD
Posted: Tuesday, June 15, 2021

Increasing numbers of patients with aggressive head and neck cutaneous squamous cell carcinoma have highlighted the need to investigate population-based trends. Cherie-Ann Nathan, MD, and colleagues from Louisiana State University, Shreveport, share results on the past 4 decades from the Surveillance, Epidemiology, and End Results (SEER) database on trends in cutaneous squamous cell carcinoma. Their findings were published in JAMA Otolaryngology–Head & Neck Surgery.

“The sex and geographic distribution of patients with cutaneous squamous cell carcinoma of the external lip has shifted over time, necessitating further inquiry into causation,” noted the authors. “Patients older than 85 years should be given special considerations for prognosis and treatment.”

A total of 15,171 cases of external lip cutaneous cell carcinoma between 1975 and 2016 were analyzed. The results from the cohort study revealed that 70.3% of the cases were from patients aged 60 years or older. Most patients (97.0%) identified as White and male (80.3%). The incidence in male patients decreased (4.4 to 0.8 per 100,000) and in female patients increased (8.4% to 26.1%) over the study period. Clinical characteristics revealed that 77.5% had localized disease on the lower lip (86.9%). A total of 51.2% of cases presented at stage I, and 96.2% were nonmetastatic. Linear regression indicated grade II and III tumors nearly tripled over the study period.

Geographic trends revealed that patients in higher latitudes had a significant increase in cases. The 5-year survival outcomes were favorable at 95.9%, however, these outcomes worsened for patients aged 75 years or older (93.2%, respectively). Over the study period, overall survival decreased over time, from a median of 125.5 months (interquartile range [IR] = 0–503 months) to 11 months (IR = 0–23 months). 

“Future analyses would benefit from population-based outcomes of primary sites, including the ear, face, and scalp, as well as frequency of perineural invasion,” the authors determined.

Disclosure: The authors reported no conflicts of interest.

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