Nodal metastasis risk up when cancer is directly on the lip
David M. Wang, from Case Western Reserve University in Cleveland, and colleagues compared differences in risks of recurrence, metastasis, and death from cutaneous squamous cell carcinoma (cSCC) on the vermilion versus cutaneous lip among 303 patients with 310 primary cSCCs of the lip (138 cutaneous and 172 vermilion) diagnosed between 2000 and 2015 at two academic tertiary care centers.
The researchers found that outcomes for vermilion versus cutaneous locations were as follows: local recurrence, 6.4 percent (11 of 172) versus 2.9 percent (four of 138); nodal metastasis, 7.6 percent (13 of 172) versus 1.5 percent (two of 138); distant metastasis, 0.6 percent (one of 172) versus 0.7 percent (one of 138); disease-specific death, 3.5 percent (six of 172) versus 2.9 percent (four of 138); and all-cause death, 26.7 percent (46 of 172) versus 29.0 percent (40 of 138). Only the difference for nodal metastasis was statistically significant (P = 0.01). In multivariable analysis, nodal metastasis was associated with vermilion lip location (subhazard ratio, 5.0) and invasion beyond fat (fascia or beyond for vermilion lip) (subhazard ratio, 4.4).
"Vermilion involvement may merit radiologic nodal staging and inclusion in future tumor staging, since it was independently associated with higher-risk cSCC of the lip region," the authors write.
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