According to a study, the researcher determined the risk of nodal metastasis is five-fold greater for skin cancer on the vermilion lip versus the cutaneous lip. The study was published in JAMA Dermatology. Researchers 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 vermilions) diagnosed between 2000 and 2015 at two academic tertiary care centers.

A retrospective cohort study of 303 patients with 310 primary cSCCs of the lip (138 cutaneous, 172 vermilions) diagnosed between 2000 and 2015 at two academic tertiary care centers in Boston, Massachusetts.

Measures

Development of local recurrence, nodal metastasis, distant metastasis, disease-specific death, and all-cause death. Of the 303 study participants with 310 SCCs of the lip, 153 (50.5%) were men, and 150 (49.5%) were women; median age at diagnosis, 68 years (range, 27-93 years). Outcomes were as follows for vermilion vs. cutaneous locations: local recurrence, 6.4% (11 of 172) vs. 2.9% (4 of 138).

A nodal metastasis, 7.6% (13 of 172) vs 1.5% (2 of 138); distant metastasis, 0.6% (1 of 172) vs 0.7% (1 of 138); disease-specific death, 3.5% (6 of 172) vs 2.9% (4 of 138); and all-cause death, 26.7% (46 of 172) vs 29.0% (40 of 138). The difference was statistically significant for nodal metastasis (P = .01). In multivariable analysis, nodal metastasis was associated with vermilion lip location (subhazard ratio, 5.0; 95% CI, 1.1-23.8) and invasion beyond fat (fascia or beyond for vermilion lip) (subhazard ratio, 4.4; 95% CI, 1.3-14.9).

Relevance  

The risk of nodal metastasis is 5-fold greater for cSCCs on the vermilion lip compared with those on the cutaneous lip. Squamous cell carcinomas of the cutaneous lip have a nodal metastasis risk similar to cSCCs in general (1.5%). Thus, vermilion involvement appears responsible for the increased risk associated with cSCC of the lip.

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.