Impact of cervical lymph node metastases from squamous cell cancer of the lip

The records of 123 patients with squamous cell cancer of the lip presenting to the Vancouver Clinic of the British Columbia Cancer Agency from 1984 and 1988 were reviewed, and 4 were excluded from the study for various reasons. Initial treatment was surgery in 40, radiotherapy in 61, and combined in 18 patients. The primary tumor was staged as TIS in 11, T1 in 57, T2 in 24, T3 in 15, T4 in 1, and undetermined in 11. Follow-up continued for a minimum of 2 years in all but five patients. Lymph node metastases developed in 19 patients, representing 18% of the 108 patients with invasive cancer. The size of the primary tumor correlated with the likelihood of metastases. The neck disease was controlled in only 8 of the 19 patients with metastases, whereas control of the primary tumor was achieved in all but 3 patients. It is concluded that the development of node metastases in patients with lip cancer is more frequent than commonly appreciated and is associated with a high mortality rate. Close follow-up is essential to allow early detection of neck involvement. Aggressive surgery is indicated when such involvement becomes evident.