Squamous cell carcinoma of the lip: a case series of distinct clinical presentations

Authors

DOI:

https://doi.org/10.5327/2525-5711.488

Keywords:

Squamous Cell Carcinoma, Lip cancer, Oral Cancer, Lip squamous cell carcinoma, Oral oncology, Risk Factors

Abstract

Typical squamous cell carcinoma of the lip generally presents as a small (<1 cm), painless, indurated ulcer that is crusted, exudative, slow-growing, and histologically well-differentiated. It most commonly occurs in fair-skinned male patients in their sixth or seventh decade of life, with primary etiological factors including UV exposure, followed by tobacco and alcohol use. This study aims to report four clinical cases of squamous cell carcinoma of the lip that exhibited presentations distinct from the classical features typically attributed to these lesions. In the first case, the carcinoma manifested as a poorly differentiated ulcer with extensive tissue destruction. The second case involved a large nodular lesion. The third case, located on the upper lip, was histologically identified as a rare variant of squamous cell carcinoma. The fourth case appeared as an ulcerated nodule and an ulcer extending to the skin. While squamous cell carcinoma of the lip is relatively common and typically exhibits non-aggressive behavior, certain cases may present with features distinct from its classical in both clinical appearance and behavior.

References

1. Biasoli ÉR, Valente VB, Mantovan B, Collado FU, Conrado Neto S, Sundefeld MLMM, et al. Lip Cancer: A Clinicopathological Study and Treatment Outcomes in a 25-Year Experience. J Oral Maxillofac Surg. 2016;74(7):1360-7. https://doi.org/10.1016/j.joms.2016.01.041

2. Moore SR, Johnson NW, Pierce AM, Wilson D. The epidemiology of lip cancer: a review of global incidence and aetiology. Oral Dis. 1999;5(3):185-95. https://doi.org/10.1111/j.1601-0825.1999.tb00300.x

3. Vieira RAMAR, Minicucci EM, Marques MEA, Marques SA. Actinic cheilitis and squamous cell carcinoma of the lip: clinical, histopathological and immunogenetic aspects. An Bras Dermatol. 2012;87(1):105-14. https://doi.org/10.1590/s0365-05962012000100013

4. Rumgay H, Colombet M, Cunha AR, Miranda-Filho A, Warnakulasuriya S, Conway DI, et al. Global incidence of lip, oral cavity, and pharyngeal cancers by subsite in 2022. CA Cancer J Clin. 2025;76(1). https://doi.org/10.3322/caac.70048

5. Li S, Yan T, Wang Q, Qu Q, Xu H, Xu N. Global Lip and Oral Cavity Cancer: Analysis of the 2021 Global Burden of Disease Study. Int Dent J 2026; 76(5):109789. https://doi.org/10.1016/j.identj.2026.109789

6. Betka J. Distant metastases from lip and oral cavity cancer. J Otorhinolaryngol Relat Spec. 2001;63(4):217-21. https://doi.org/10.1159/000055744

7. Casal D, Carmo L, Melancia T, Zagalo C, Cid O, Rosa-Santos J. Lip cancer: A 5-year review in a tertiary referral centre. J Plast Reconstr Aesthet Surg. 2010;63(12):2040-5. https://doi.org/10.1016/j.bjps.2009.12.022

8. Gutiérrez-Pascual M, Vicente-Martín FJ, Fernández-Álvarez JG, Martín-López R, Pinedo-Moraleda F, López-Estebaranz JL. Squamous cell carcinoma of the lip. A retrospective study of 146 patients. J Eur Acad Dermatol Venereol. 2012;26(9):1116-21. https://doi.org/10.1111/j.1468-3083.2011.04227.x

9. Luna-Ortiz K, Güemes-Meza A, Villavicencio-Valencia V, Mosqueda-Taylor A. Lip cancer experience in Mexico. An 11-year retrospective study. Oral Oncol. 2004;40(10):992-9. https://doi.org/10.1016/j.oraloncology.2004.04.013

10. Salgarelli AC, Sartorelli F, Cangiano A, Pagani R, Collini M. Surgical Treatment of Lip Cancer: Our Experience With 106 Cases. J Oral Maxillofac Surg. 2009;67(4):840-5. https://doi.org/10.1016/j.joms.2008.09.020

11. Souza LR, Fonseca-Fonseca T, Oliveira-Santos CC, Corrêa GTB, Santos FBG, Cardoso CM, et al. Lip squamous cell carcinoma in a Brazilian population: Epidemiological study and clinicopathological associations. Med Oral Patol Oral Cir Bucal. 2011;16(6):e757-62. https://doi.org/10.4317/medoral.16954

12. Girardi FM, de Farias Gabriel A, Wagner VP, Martins MD. Second events after curative-intent treatment for lip cancer: navigating the path of follow-up care. Oral Dis. 2025;31(4):1189-97. https://doi.org/10.1111/odi.15194

13. Babu G, Ravikumar R, Rafi M, Nair LM, Nazeer F, Thomas S, et al. Treatment outcomes of squamous cell carcinoma of the lip: A retrospective study. Oncol Lett. 2022;25(1):8. https://doi.org/10.3892/ol.2022.13594

14. Louredo BVR, Vargas PA, Pérez-de-Oliveira ME, Lopes MA, Kowalski LP, Curado MP. Epidemiology and survival outcomes of lip, oral cavity, and oropharyngeal squamous cell carcinoma in a southeast Brazilian population. Med Oral Patol Oral Cir Bucal. 2022;27(3):e274-84. https://doi.org/10.4317/medoral.25147

15. Milano AF. Lip cancer: 20-year comparative survival and mortality analysis by age, sex, race, stage, grade, cohort entry time-period and disease duration A systematic review of 19,213 cases for diagnosis years 1973-2014: (SEER*Stat 8.3.5). J Insur Med. 2023;49(4):1-12. https://doi.org/10.17849/insm-49-4-1-12.1

16. Silva LVO, Arruda JAA, Abreu LG, Ferreira RC, Silva LP, Pelissari C, et al. Demographic and Clinicopathologic Features of Actinic Cheilitis and Lip Squamous Cell Carcinoma: a Brazilian Multicentre Study. Head Neck Pathol. 2020;14(4):899-908. https://doi.org/10.1007/s12105-020-01142-2

17. Hwang JR, Khachemoune A. Lower lip basal cell and squamous cell carcinomas: a reappraisal of the similarities and differences in clinical presentation and management. Arch Dermatol Res. 2023;315(2):117-25. https://doi.org/10.1007/s00403-022-02345-z

18. Géraud C, Koenen W, Neumayr L, Doobe G, Schmieder A, Weiss C, et al. Lip cancer: retrospective analysis of 181 cases. J Dtsch Dermatol Ges. 2012;10(2):121-7. https://doi.org/10.1111/j.1610-0387.2011.07853.x

19. Kristensen RN, Stemann Andersen P, Lock-Andersen J. Lip carcinoma: clinical presentation, surgical treatment, and outcome: a series of 108 cases from Denmark. J Plast Surg Hand Surg. 2017;51(5):342-7. https://doi.org/10.1080/2000656x.2016.1270215

20. Kansara S, Oral E, Sarkar I, Sandulache V, Mualla R, Walvekar RR, et al. Rate of occult metastasis in lip squamous cell carcinoma: A systematic review and meta-analysis. Head Neck. 2024;46(10):2517-23. https://doi.org/10.1002/hed.27747

21. Kowalski LP, France EL, Torloni H, Fava AS, Andrade Sobrinho J, Ramos G, et al. Papers Lateness of Diagnosis of Oral and Oropharyngeal Carcinoma: Factors Related to the Tumour, the Patient and Health Professionals. Eur J Cancer B Oral Oncol. 1994;30B(3):167-73. https://doi.org/10.1016/0964-1955(94)90086-8

22. Girardi FM, Martins MD. Controversies in lip cancer staging assessment: insights and perspectives. Oral Dis. 2025;31(7):2350-1. https://doi.org/10.1111/odi.15298

23. Batista AC, Costa NL, Oton-Leite AF, Mendonça EF, Alencar RCG, Silva TA. Distinctive clinical and microscopic features of squamous cell carcinoma of oral cavity and lip. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(3):e74-9. https://doi.org/10.1016/j.tripleo.2009.10.034

24. Mello FW, Melo G, Modolo F, Rivero ERC. Actinic cheilitis and lip squamous cell carcinoma: Literature review and new data from Brazil. J Clin Exp Dent. 2019;11(1):e62-9. https://doi.org/10.4317/jced.55133

25. Fritsch VA, Lentsch EJ. Basaloid squamous cell carcinoma of the head and neck: Location means everything. J Surg Oncol. 2014;109(6):616-22. https://doi.org/10.1002/jso.23536

26. Pereira MC, Oliveira DT, Landman G, Kowalski LP. Histologic Subtypes of Oral Squamous Cell Carcinoma: Prognostic Relevance. J Can Dent Assoc. 2007;73(4):339-44.

27. Kapustin JE, Comess SR, Nurimba M, Kwon I, Khorsandi A, Brandwein-Weber M, et al. Basaloid squamous cell carcinoma of the midline dorsal tongue: case report and review of the literature. Head Neck. 2026. https://doi.org/10.1002/hed.70250

28. Coppola D, Catalano E, Tang C‐K, Elfenbein IB, Harwick R, Mohr R. Basaloid squamous cell carcinoma of floor of mouth. Cancer. 1993;72(8):2299-305. https://doi.org/10.1002/1097-0142(19931015)72:8%3C2299::aid-cncr2820720803%3E3.0.co;2-2

29. El-Mofty SK. Histopathologic risk factors in oral and oropharyngeal squamous cell carcinoma variants : An update with special reference to HPV-related carcinomas. Med Oral Patol Oral Cir Bucal. 2014;19(4):e377-85. https://doi.org/10.4317/medoral.20184

30. Ereño C, Gaafar A, Garmendia M, Etxerraga C, Bilbao FJ, López JI Basaloid Squamous cell carcinoma of the head and neck: a clinicopathological and follow-up study of 40 cases and review of the literature. Head Neck Pathol. 2008;2:83-91. https://doi.org/10.1007/s12105-008-0045-6

31. Maruccia M, Onesti MG, Parisi P, Cigna E, Troccola A, Scuderi N. Lip cancer: a 10-year retrospective epidemiological study. Anticancer Res. 2012;32(4):1543-6.

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Published

2026-09-02

How to Cite

1.
Santos BC, Ito FA, Takahama Junior A. Squamous cell carcinoma of the lip: a case series of distinct clinical presentations. J Oral Diagn [Internet]. 2026 Sept. 2 [cited 2026 Oct. 15];11. Available from: https://www.jordi.com.br/revista/article/view/488

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Case Report