Treatment of Advanced-Stage (T3/T4) Lip Cancer at the Commissure Requiring Reconstruction
Advanced malignant neoplasm of the oral commissure — staged T3 or T4, with a primary tumour exceeding 4 cm in greatest dimension — presents distinct surgical challenges. Larger lesions require substantially more consideration with regard to reconstruction techniques than early-stage disease, and five-year survival rates for T3/T4 tumours are markedly lower than for T1/T2 disease.
Clinical scenario
Larger or advanced-stage (T3/T4) malignant neoplasm of the commissure of lip; primary tumour greater than 4 cm in greatest dimension, with reconstruction of the lip required following excision.
Surgical approach — partial overview
Management centres on surgical excision of the lip tumour with reconstruction using full-thickness skin flaps, ensuring sufficient mucosa contiguous to the commissure to prevent contracture. The choice of reconstruction technique is guided by the size and location of the defect, and neck dissection is considered based on clinical assessment of cervical lymph nodes.
The full selection algorithm — including specific flap options by defect size for both lower and upper lip — is available in the complete protocol below.References
DOI: 10.1017/S0022215116000499
- Larger lesions of the lip require more consideration with regard to reconstruction techniques.
- The five-year crude survival rates for surgical treatment are about 75–80 per cent for T1 to T2 tumours, dropping to 40–50 per cent for T3 and T4 tumours.
- Whenever possible full thickness skin flaps (skin, muscle and mucosa) should be used.
- The repair should provide sufficient mucosa contiguous to the commissure to avoid contracture.
- Neck dissection is generally not performed in the absence of clinically suspicious cervical lymph nodes as more than 5 per cent of patients are likely to develop recurrence in the neck following treatment of the primary lesion.