AIM: Carcinoma of the lip is the most common neoplasm of the oral cavity; it mainly affects males, especially after the fifth decade of life, with an history of prolonged exposure to sunlight, poor oral hygiene, inadequate diet, abuse of alcohol and smoking.The most frequent are squamous cell carcinomas, while more infrequent are basal cell carcinomas and adenocarcinomas; melanomas are frequent only in exceptional cases. Early diagnosis is essential to prevent the worsening of the disease and malignancy.
The therapeutic approach is contrasting: radiation therapy is recommended in case of small lesions especially in the upper lip or in the labial commisure, even though surgery seems to be the first choice especially for invasive lesions.
The aim of the present study is to document three cases of carcinoma of the lip without early diagnosis.
Two male patients, respectively with 74 and 65 years of age, presented with a small lesion; the physical examination was performed after taking their medical history; then, surgery was performed with a reduced aesthetic damage for the patients, since the two lesions were less than 2 cm and they did not affect the lymph node regions. After excluding the location of tumor into other areas (stage I), the tumor was removed with a margin of healthy tissue.
The third 78-year-old patient required a destructive surgery given the extent of the lesion up to the chin area (Berard?s surgery). The greatest difficulty that the surgeon encountered during reconstruction was to ensure a good reconstruction of the lower lip in order to obtain an adequate lip competence.
Physical examination revealed a layer of abnormal oral mucosa in the three lesions; the histological examination showed cell changes after biopsy.
Lip cancer affects males over the age of 40, white race more than black race, probably due to the protection provided by melanin. The initial lesions are not painful, they have undefined margins and infiltrate only a little in the surrounding tissue; they may be dyskeratosic areas with superficial crusting that can be easily removed with minimal bleeding, or they may be infiltrating and vegetating with a slow growth. Histologically, both the epithelium and the underlying connective tissue are involved.
Tumors of the lip and of the oral cavity are often diagnosed during a dental check-up .
It is essential to go to the specialist in case of a small protuberance on the lip, in the mouth or gums, in case of a small lesion in the mouth that does not heal or with a white-reddish stain that does not disappear.
The differential diagnosis is crucial with ulcerating inflammatory lesions, since they are chronic, symmetric and non-infiltrating, as well as the “diagnostic delay” according to the medical staff involved and to the objective assessment of the lesion: the presence of a tumefaction persisting on the oral mucosa or a wound that does not heal can be a warning sign of a pre-tumor or tumor lesion of the oral cavity.
It is advisable to follow the indications of the oncologist in case he/she recommends to participate in clinical trials aiming at the evaluation of new combinations of anticancer products and/or new therapeutic protocols .