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Squamous Cell Carcinoma of the Lip: Is There a Difference Between Vermilion vs Cutaneous Involvement?

By: Joseph Fanelli
Posted: Wednesday, July 18, 2018

Cutaneous squamous cell carcinomas on the cutaneous lip are low-risk tumors compared with cutaneous squamous cell tumors on the vermilion, which have considerable risk for nodal metastasis, according to study findings published in JAMA Dermatology. Chrysalyne D. Schmults, MD, MSCE, of Brigham and Women’s Hospital, Harvard medical School, Boston, and colleagues, found that the risk for nodal metastasis was five times greater in the vermilion lip, whereas squamous cell carcinomas of the cutaneous lip had a risk of nodal metastasis similar to that for cutaneous squamous cell tumors in general (1.5%).

“Vermilion involvement may merit radiologic nodal staging and inclusion in future tumor staging, since it was independently associated with higher-risk [cutaneous squamous cell carcinoma] of the lip region,” the authors concluded.

In the retrospective cohort study, the investigators analyzed 303 patients with 310 cutaneous squamous cell carcinomas of the lip (138 cutaneous, 172 vermilion). The patients were diagnosed at two academic tertiary care centers in Boston between 2000 and 2015.

The results showed local recurrence of 2.9% and 6.4% for cutaneous and vermilion populations, respectively; nodal metastasis of 1.5% and 7.6%; and distant metastasis of 0.7% and 0.6%. The rate of disease-specific death was 2.9% in the cutaneous group and 3.5% in the vermilion cohort, and the rate for all-cause death was 29.0% and 26.7%, respectively. The investigators found that in a multivariable analysis, nodal metastasis was linked to vermilion lip location (suhazard ratio of 5.0) and invasion beyond fat (subhazard ratio of 4.4).


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