In a study reported in JAMA Dermatology, Wang et al found that risk of nodal metastasis was higher for cutaneous squamous cell carcinoma (SCC) of the lip with vermilion vs cutaneous location. Disease-specific and overall survival were similar for the two locations.
The retrospective cohort study involved 303 patients with 310 primary cutaneous SCCs of the lip, consisting of 138 cutaneous and 172 vermilion lesions, diagnosed between 2000 and 2015 at Brigham and Women’s Hospital and Massachusetts General Hospital. Median age at diagnosis was 68 years (range = 27–93 years) and 50.5% of patients were male.
Outcomes for Vermilion vs Cutaneous Location
Median follow-up was 49.6 months. For vermilion vs cutaneous locations, rates were 6.4% vs 2.9% for local recurrence (P = .15), 7.6% vs 1.5% for nodal metastasis (P = .01), 0.6% vs 0.7% for distant metastasis (P = nonsignificant), 3.5% vs 2.9% for disease-specific death (P > .99), and 26.7% vs 29.0% for all-cause death (P = .66). In multivariable analysis, nodal metastasis was associated with vermilion lip location (subhazard ratio = 5.0, 95% confidence interval [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).
The investigators concluded, “The risk of nodal metastasis is fivefold greater for cutaneous SCCs 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 cutaneous SCCs in general (1.5%). Thus, vermilion involvement appears responsible for the increased risk associated with cutaneous SCC of lip. Vermilion involvement may merit radiologic nodal staging and inclusion in future tumor staging, since it was independently associated with higher-risk cutaneous SCC of the lip region.”
Chrysalyne D. Schmults, MD, of the Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, is the corresponding author for the JAMA Dermatology article.
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