Serdar DÜZGÜN, MD; Erkin ÜNLÜ, MD; İlhan PEKDEMIR, MD; Sedat YILANCI, MD; Ramazan Erkin ÜNLÜ, MD Management of Squamous Cell Carcinoma of The Lower Lip: Analysis of Five Years' Experience (78 Patients) and Review of The Literature KBB-Forum 2013;12(2) www.KBB-Forum.net CLINICAL STUDY MANAGEMENT OF SQUAMOUS CELL CARCINOMA OF THE LOWER LIP: ANALYSIS OF FIVE YEARS' EXPERIENCE (78 PATİENTS) AND REVIEW OF THE LITERATURE Serdar DÜZGÜN, MD; Erkin ÜNLÜ, MD; İlhan PEKDEMIR, MD; Sedat YILANCI, MD Ankara Numune Eğitim ve Araştırma Hastanesi, Plastik Cerrahi, Ankara, Turkey SUMMARY The most frequent type of all oral cavity tumors, squamous cell type (SCC) has currently been reported to account for 90% of all malignant oral tumors. Lips are the most common localization after skin in the head and neck region for the squamous cell carcinomas to involve. Among the pivotal risk factors having impact on the prognosis are as follows: size of the tumor, histopathological type and grade, perineural invasion, regional lymph node metastasis, and local recurrences. The present retrospective study included a total of 78 patients with SCC of the lower lip who had been treated in the second Plastic Surgery Clinic in Ankara Numune Training and Research Hospital between 2007 and 2011. Such characteristics as age, gender, lesion localization, presence of palpable lymph nodes in the physical examination, ultrasonographic presence of cervical metastasis, pathology reports, cervical lymph node dissection and the results of the reconstructive operations undertaken were compared, thus proposing an algorithm in the light of the collected data. When diagnostic and treatment modalities are implemented appropriately and in the early period, the survival period and the quality of life change in a positive way. Particularly, we have concluded that lymph node dissections have a positive impact on the survival and reduce the recurrence rates. Keywords: Lower lip, squamous cell carcinoma, lip ALT DUDAK SCC Lİ HASTALARDA TANI VE TEDAVİ 5 YILLIK DENEYİM (78 HASTA) VE LİTERATÜRÜN GÖZDEN GEÇİRİLMESİ ÖZET Son zamanlarda oral kavite tumorleri arasında en sık olan yassı hücreli tipin (scc) oral kavite tümörlerinin %90'ini teşkil ettiği belirtilmiştir. Scc için baş ve boyun derisinden sonraki en sık tutulum lokalizasyonu dudaklardır. Bilinen risk faktörleri arasında prognoza etkisi olan faktörler şunlardır: tümor boyutları, histopatolojik tip ve evre, perinöral invazyon, bölgesel lenf nodu metastazi ve lokal rekürrensler. Yapılan retrospektif çalısmada kliniğimizde 2007-2011 yıllari arasında alt dudak scc tanısıyla tedavi edilmiş 78 hasta dahil edilmiştir. Yapılan çalısmada yaş, cinsiyet, lezyonun lokalizasyonu, fizik muayenede palpe edilebilir lenf nodu varlığı, ultrasonografik servikal metastazi mevcudiyeti, patoloji raporları, lenf nodu disseksiyonu ve yapılan rekonstruktif operasyonun sonuçları gibi nitelikler karşılaştırılmış böylece toplanmış olan verinin ışığında bu tip hastaların tedavisinde bir algoritma önerilmektedir. Tanı ve tedavi metodları özellikle de erken dönemde uygun şekilde uygulandığında hayatta kalım süresi ve yaşam kalitesi olumlu yönde değişmektedir. Tarafımızdan özellikle lenf nodu disseksiyonunun hayatta kalım üzerine pozitif etkisi olduğu ve rekurrens oranlarını azalttığı sonucuna varılmıştır. Anahtar Sözcükler: Alt dudak, skuamöz hücreli karsinom, dudak INTRODUCTION Lip cancers are among the most common malignancies observed in the head-neck region, and constitute 25% of all cancers encountered in the oral cavity. As the most frequent type of all oral cavity tumors, squamous cell type (SCC) has currently been reported to account for 90% of all malignant oral tumors. Lips are the most common localization after skin in the head and neck region for the squamous cell carcinomas to involve 1 . The incidence increases with age, reaching a peak in the seventh and eighth decades.5,9 The lower lip is affected far more frequently (80% to 95%) than the upper lip (2% to 12%) or commissure (1% to 15%) 2 . The majority of SCCs of the lower lip stems from the vermillion border. Corresponding Author: Serdar Düzgün MD Ankara Numune Eğitim ve Araştırma Hastanesi, Plastik Cerrahi, Ankara, Turkey, E-mail: serdarduzgun@gmail.com Received: 25 December 2012, revised for: 01 April 2013, accepted for publication: 01 April 2013 Lip cancers have a common predilection for white races especially in the 6th decade of life. The etiology of lip cancer is multifactorial, with exposure to the sun, previous radiotherapy, genetic predisposition (mutation of the p53 suppressor gene), and tobacco smoke playing important roles 2 . Although the SCCs localized on the lips have been regarded among the most common malignancies, higher cure rates are achieved compared with the other malignancies of head-neck region. In conjunction with the boosting rates of diagnosis and treatment especially in the initial stages in recent years, cure rates have been progressively increasing (83-96%); moreover, the significance of a meticulous evaluation for probable presence of metastasis in the regional lymph nodes have also been emphasized 4 . Surgery and radiotherapy stand for the therapeutic approaches known to be effective in the treatment of cancers of the lower lip, with successful results reported for both of the treatment modalities. In addition, evaluation of the cervical lymph nodes 26