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Cutaneous Squamous Cell Carcinoma of the Lip and Risk of Nodal Metastasis


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In a study reported in JAMA Dermatology, Wang et al found that the risk of nodal metastasis was higher for cutaneous squamous cell carcinoma of the lip with vermilion vs cutaneous location. Disease-specific and overall survival were similar for the two locations. Chrysalyne D. Schmults, MD, of the Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, is the corresponding author of the JAMA Dermatology article.

Chrysalyne D. Schmults, MD

Chrysalyne D. Schmults, MD

The retrospective cohort study involved 303 patients with 310 primary cutaneous squamous cell carcinomas 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. The median age at diagnosis was 68 years (range = 27–93 years), and 50.5% of patients were male.

Outcomes for Vermilion vs Cutaneous Location

The 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 [squamous cell carcinomas] 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 [squamous cell carcinoma] in general (1.5%). Thus, vermilion involvement appears responsible for the increased risk associated with cutaneous [squamous cell carcinoma] of lip. Vermilion involvement may merit radiologic nodal staging and inclusion in future tumor staging, since it was independently associated with higher-risk cutaneous [squamous cell carcinoma] of the lip region.” ■

Wang DM, et al: JAMA Dermatol 154:701-707, 2018.


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