Non-healing ulcer of the lower lip

Invasive cutaneous squamous cell carcinoma, lower lip — BWH T2b (2 risk factors)

Learning points

• Lip cSCC is a high-risk site with metastatic potential significantly higher than body-site cSCC.
• BWH T-stage outperforms AJCC 8 for prognostic discrimination — diameter ≥ 2 cm and invasion beyond fat give 2 risk factors → T2b, the BWH tier associated with roughly 20% nodal metastasis in cohort data.
• Imaging: ultrasound nodes ± MRI lip and mandible at baseline; MDT discussion mandatory for high-risk cSCC.
• Reconstruction of the lower lip must preserve oral competence — Karapandzic flap is workhorse for 1/3–2/3 defects with dynamic preservation.
• Adjuvant radiotherapy considered for PNI of named nerve, ECE, multiple involved nodes, or close/positive margin where re-excision is not feasible.