Surgical treatment of squamous cell carcinoma of the lower lip: evaluation of long-term results and prognostic factors--a retrospective analysis of 184 patients.

PURPOSE: A retrospective study was undertaken to evaluate the results of surgical treatment of primary squamous cell carcinoma of the vermilion border of the lower lip and to identify parameters of the primary tumor that may predict local recurrence and regional metastasis. PATIENTS AND METHODS: From 1979 through 1992, 184 consecutive patients with a primary squamous cell carcinoma of the lower lip underwent surgical excision as a primary treatment. There were 166 (90.2%) men and 18 (9.8%) women, with a mean age of 66 years. Most cases (92.9%) were stage I tumors. Most of the tumors were well and moderately differentiated squamous cell carcinomas (93.5%). Minimal follow-up was 2 years, with a mean of 56 months. Disease control was achieved in 165 (89.7%) patients. Local recurrence and regional metastasis occurred in 9 (4.9%) and 10 (5.4%) patients, respectively. Local failures were treated successfully by either surgery or radiation therapy. Regional metastases were treated in nine patients by neck dissection, followed in eight cases by radiation therapy. One patient developed distant metastasis.
RESULTS: Five- and 10-year overall survival rates were 78% and 61%, respectively, whereas the disease-free survival rates at 5 and 10 years were 86% and 81%, respectively. Multivariate analysis indicated that local recurrence was significantly associated with large tumor size and surgical margins containing squamous cell carcinoma. Increasing tumor thickness, an infiltrative invasion pattern, and perineural invasion were significant prognostic indicators of regional metastasis.
CONCLUSION: Surgical treatment for small squamous cell carcinomas of the lower lip has a favorable prognosis. Particular parameters of the primary tumor seem to predict the chance of development of local recurrence and regional lymph node metastasis.