29 July 2021

This is a common area for skin cancers and needs to be excised (removed) adequately and the post-excisional defect well repaired, to leave the patient with good form (appearance) and function.
During excision, the underlying muscle and vestibular mucosa (the inner lining of the lip) is also removed to achieve a good result.

However, in Mr JG, a 56 year old man, who was a regular smoker, the lesion on his lower lip was very extensive.

Skin Cancer of the Lip

Cancer marked out with usual resection margins (Figure 1 P1013642)

The standard treatment would have involved extensive resection (removal) of muscle and mucosa.

This is possible and often gives a good outcome, as seen in Miss KW, a 55 year old lady with an extensive skin cancer involving the upper lip and cheek:

Skin Cancer of the Lip

Figure 2 – P3247412 – Before Surgery

Skin Cancer of the Lip

Figure 3 – P3247420 – During Surgery

Skin Cancer of the Lip

Figure 4 – P3247423 – During Surgery

Skin Cancer of the Lip

Figure 5 – P6151166 – Four years later

Skin Cancer of the Lip

Figure 6 – P6151167 – Four years later

In Mr JG, as the lesion was much larger, it was decided to treat the problem with a different approach.
The tumour was excised including mucosa and all submucosal tissue, down to the muscle layer.
At surgery it was clear the tumour was still in the deeper mucosa (deep papillary dermal layer) and had not gone to the muscle layer.

The large mucosal defect was made good (repaired) by extensive mobilisation of the vestibular mucosa (the inner lining of the lower lip) while the muscle layer was preserved.

The pathology report confirmed complete removal of tumour.

Skin Cancer of the Lip

Figure 7 – P1013643 – After surgery

Skin Cancer of the Lip

Figure 8 – P1012644 – After surgery

Skin Cancer of the Lip

Figure 9 – P1013645 – After surgery

Skin Cancer of the Lip

Figure 10 – P5240211

Skin Cancer of the Lip

Figure 11 – P5240212

Skin cancers of the face are difficult to treat – early treatment is best but if the problem is extensive, an expert Plastic Surgeon often helps in achieving a good outcome.

About The Author - Dr Chandran Arianayagam

Dr Chandran Arianayagam is an internationally trained Specialist Plastic Surgeon. Based in Coffs Harbour since January 1995, he has trained and worked in India, Malaysia, the United Kingdom, United States and Australia. He brings 30 years of experience and expertise to the Mid-North Coast region.

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