{"entity":{"id":"lip-cancer","kind":"cancer","name":"Lip cancer","aka":["Lower lip squamous cell carcinoma","Cancer of the lip vermilion"],"tldr":"Cancer of the lip is really a skin cancer of the sun-exposed lower lip, usually found early because it can be seen. A small operation or radiotherapy cures most people, and reconstruction keeps the mouth working.","summary":"Lip cancer is squamous cell carcinoma of the vermilion, the red part of the lip, and the great majority arise on the lower lip, which faces the sun, in fair-skinned men who work outdoors or smoke, often from a precursor patch of actinic cheilitis. Upper lip tumours are more often basal cell carcinomas spreading from the skin. Because the eighth edition of the staging system moved vermilion lip cancer into the skin cancer chapter, only cancer of the inner mucosal lip is now staged with the oral cavity, though lip cancer is still treated by head and neck teams.\n\nMost tumours are small when found and are cured by wedge excision, closed directly or, for larger defects, with Abbe, Estlander or Karapandzic flaps that keep the mouth competent and mobile. Radiotherapy, by external beam or brachytherapy, is an equally effective alternative, chosen for tumours at the commissure or in patients unfit for surgery. Nodal spread is uncommon in small tumours, so the neck is observed or staged with sentinel node biopsy and dissected only when nodes are found or the primary is large, thick or has perineural invasion.\n\nAdvanced tumours invading the jaw or with nodal spread are treated with resection, neck dissection and postoperative radiotherapy, with cisplatin for extranodal extension or positive margins, and unresectable or metastatic disease is treated as cutaneous squamous cell carcinoma with cemiplimab or as head and neck squamous cell carcinoma with pembrolizumab. Sun protection and smoking cessation prevent most cases, and treating actinic cheilitis prevents progression.","asOf":"2026-09-17","wikipedia":"https://en.wikipedia.org/wiki/Lip_cancer","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Lip_cancer"}],"tags":["subtype-page","head-and-neck"],"related":["buccal-mucosa-cancer","oral-tongue-cancer"],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["empower-cscc-1"],"people":[],"bottlenecks":[],"keyPapers":["paper-keynote-048-lancet-2019","paper-bonner-cetuximab-radiotherapy-nejm-2006","paper-bernier-eortc-22931-nejm-2004","paper-empower-cscc-1-cemiplimab-migden-nejm-2018"],"journals":[],"dependsOn":[],"notes":[],"group":"head and neck","burden":"Mostly squamous cell carcinoma of the lower lip in fair-skinned outdoor workers and smokers; it is caught early because it is visible, and excision or radiotherapy cures the great majority.","subtypes":["Lower lip squamous cell carcinoma (sun and tobacco related)","Upper lip cancer (often basal cell carcinoma)","Commissure (corner of the mouth) cancer","Mucosal lip cancer staged with the oral cavity","Actinic cheilitis (precursor)"],"biomarkers":["Tumour thickness and depth","Perineural invasion","Margin status","Immunosuppression (transplant recipients)","PD-L1 (advanced disease)"],"standardOfCare":[{"setting":"Early disease","approach":"Wedge or V excision with local flap reconstruction, or radiotherapy (external beam or brachytherapy) for commissure tumours or unfit patients.","refs":["imrt-igrt","brachytherapy"],"guideline":{"nccn":"Category 2A","version":"NCCN Guidelines: Head and Neck Cancers","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1437"}},{"setting":"Large, thick or node-positive disease","approach":"Resection with flap reconstruction, sentinel node biopsy or neck dissection, and postoperative radiotherapy; cisplatin for extranodal extension or positive margins.","refs":["imrt-igrt","sentinel-node","cisplatin","chemoradiation"],"guideline":{"nccn":"Category 2A","version":"NCCN Guidelines: Head and Neck Cancers","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1437"}},{"setting":"Unresectable or metastatic","approach":"Cemiplimab as for cutaneous squamous cell carcinoma, or pembrolizumab-based treatment as for head and neck squamous cell carcinoma.","refs":["cemiplimab","pembrolizumab","keynote-048"],"guideline":{"nccn":"Category 2A","version":"NCCN Guidelines: Head and Neck Cancers","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1437"}},{"setting":"Prevention","approach":"Sun protection of the lips, smoking cessation, and treatment of actinic cheilitis.","refs":["smoking-cessation-after-diagnosis"]}],"stateOfArt":["Local flap techniques a century old still give the best functional results.","Radiotherapy and surgery cure similar proportions, so the choice rests on function and cosmesis.","Immunotherapy for cutaneous squamous cell carcinoma now covers the rare advanced lip cancer."],"history":[{"year":1898,"title":"Abbe describes the cross-lip flap","refs":[]},{"year":1974,"title":"Karapandzic describes the neurovascular flap that keeps the mouth working","refs":[]},{"year":2017,"title":"Vermilion lip cancer moves to the skin cancer staging chapter (AJCC 8th edition)","refs":[]}],"pipeline":["cemiplimab"],"openProblems":["Lip cancer in outdoor workers in sunny countries is under-recognised and under-protected.","Function and appearance after resection of more than half the lip.","Whether sentinel node biopsy should be routine for thicker tumours."],"parent":"oral-cavity-cancer"},"route":"/cancers/lip-cancer/","neighbours":{"cancer":[{"id":"buccal-mucosa-cancer","kind":"cancer","name":"Buccal mucosa and gingivobuccal cancer (oral cancer in India)","route":"/cancers/buccal-mucosa-cancer/"},{"id":"oral-cavity-cancer","kind":"cancer","name":"Oral cavity cancer (mouth and tongue)","route":"/cancers/oral-cavity-cancer/"},{"id":"oral-tongue-cancer","kind":"cancer","name":"Oral tongue and floor of mouth cancer","route":"/cancers/oral-tongue-cancer/"}],"trial":[{"id":"empower-cscc-1","kind":"trial","name":"EMPOWER-CSCC-1","route":"/trials/empower-cscc-1/"},{"id":"keynote-048","kind":"trial","name":"KEYNOTE-048","route":"/trials/keynote-048/"}],"paper":[{"id":"paper-bernier-eortc-22931-nejm-2004","kind":"paper","name":"EORTC 22931: postoperative irradiation with or without concomitant cisplatin for locally advanced head and neck cancer","route":"/key-papers/paper-bernier-eortc-22931-nejm-2004/"},{"id":"paper-keynote-048-lancet-2019","kind":"paper","name":"KEYNOTE-048: pembrolizumab, alone or with chemotherapy, as first treatment for recurrent or metastatic head and neck cancer","route":"/key-papers/paper-keynote-048-lancet-2019/"},{"id":"paper-empower-cscc-1-cemiplimab-migden-nejm-2018","kind":"paper","name":"PD-1 blockade with cemiplimab in advanced cutaneous squamous cell carcinoma (EMPOWER-CSCC-1)","route":"/key-papers/paper-empower-cscc-1-cemiplimab-migden-nejm-2018/"},{"id":"paper-bonner-cetuximab-radiotherapy-nejm-2006","kind":"paper","name":"Radiotherapy plus cetuximab for locoregionally advanced squamous cell carcinoma of the head and neck","route":"/key-papers/paper-bonner-cetuximab-radiotherapy-nejm-2006/"}],"drug":[{"id":"cemiplimab","kind":"drug","name":"Cemiplimab","route":"/drugs/cemiplimab/"},{"id":"cisplatin","kind":"drug","name":"Cisplatin","route":"/drugs/cisplatin/"},{"id":"pembrolizumab","kind":"drug","name":"Pembrolizumab","route":"/drugs/pembrolizumab/"}],"technology":[{"id":"brachytherapy","kind":"technology","name":"Brachytherapy","route":"/technologies/brachytherapy/"},{"id":"imrt-igrt","kind":"technology","name":"IMRT / IGRT (modern external beam)","route":"/technologies/imrt-igrt/"},{"id":"sentinel-node","kind":"technology","name":"Sentinel lymph node biopsy","route":"/technologies/sentinel-node/"},{"id":"smoking-cessation-after-diagnosis","kind":"technology","name":"Smoking cessation in cancer patients","route":"/technologies/smoking-cessation-after-diagnosis/"}],"term":[{"id":"chemoradiation","kind":"term","name":"Chemoradiation (chemoradiotherapy, CRT)","route":"/terms/chemoradiation/"}]}}