Perineural spread of squamous cell carcinoma involving trigeminal and facial nerves

Perineural spread of squamous cell carcinomas in the orofacial region predominantly involves the trigeminal and facial nerves. Central spread, particularly along the trigeminal nerve, produces sensory impairment and involvement of other divisions through invasion of the gasserian ganglion, as illustrated in these case reports. Early diagnosis and medical referral is important because central invasion has a poor prognosis.     

Keratoacanthoma versus squamous cell carcinoma of the lower lip

The authors' aim in this study is to discuss and review, from the presentation of a keratoacanthoma case with a clinical diagnosis of squamous cell carcinoma, the clinical and histologic criteria for a differential diagnosis between these two lesions, as well as to analyze the factors presumably involved in keratoacanthoma formation.     

Recurrent squamous cell carcinoma of the lower lip: salvage surgery outcome

Squamous cell carcinoma (SCC) of the lip is one of the most commonly occurring oral cancers, mainly involving the lower lip. Despite a good prognosis in cases of early detection, survival rates drop dramatically in the presence of recurrence. While there are many studies in the literature regarding the management of primary tumours, the rate of recurrence in lower lip SCC is low and therefore there are few data and articles about them. We retrospectively reviewed patients affected by recurrent SCC of the lower lip treated surgically from 2011 to 2019 in a single centre. Data and results were compared with those in the literature. A total of 16 patients (mean [range] age: 78.1 [62-93] years) were eligible for inclusion. The disease-free survival rate at 2 and 5 years was 29.6% and the overall survival rate at 2 and 5 years was 14.4%. A significantly higher rate of failure and a worse prognosis was observed in patients with neck involvement. The prognosis of recurrent lower lip SCC is unfavourable with extremely low survival rates. This issue is probably linked to the oncological pathology but also to the advanced age of most patients, the presence of several comorbidities and, consequently, the high risk of perioperative mortality. For this reason, the analysis of data sets reported in the literature may help the surgeon in the management of recurrences and selection of patients.     

影响唇鳞癌预后的临床病理因素分析

目的研究影响唇鳞癌预后的临床病理因素.方法以各临床病理指标来研究与唇鳞癌预后有关的因素.结果 1.区域淋巴结转移:T1有5.4%,T2有6.5%,T3有41.7%的病例出现区域淋巴结转移(0.01＜P＜0.025).高、中、低分化出现淋巴结转移者分别为3.6%、6.7%和66.7%(P＜0.005).出现淋巴结转移者的病理核分裂数为3.25个,明显高于未出现淋巴结转移(P＜0.01).而浸润厚度和微血管数与淋巴结转移无关.2.术后复发:复发组浸润厚度为5.07mm,明显高于无复发组(P＜0.05);而且复发组的病理核分裂数也明显高于无复发组.高、中、低分化者出现复发的分别为7.1%、13.3%、55.6%(P＜0.005);从淋巴细胞浸润程度来看,两组间无明确关系.结论肿瘤直径大、分化程度低、病理核分裂数大于3个时,易出现区域淋巴结转移.浸润厚度大于5mm、病理核分裂数大于2个、分化程度低时易出现复发.淋巴细胞浸润程度及微血管数与区域淋巴结转移和复发无关.     

Treatment of squamous cell carcinoma of the lip using Foscan-mediated photodynamic therapy

Carcinoma of the lip is a common cancer of the head and neck area; its incidence is approximately one-quarter that for oral cavity cancers. It occurs most frequently on the lower lip of elderly males. This non-randomized Phase II study aimed to estimate the complete response (CR) rate to Foscan-mediated photodynamic therapy (Foscan-PDT) in patients with primary cancer of the lip, duration of CR, and the tolerability and safety of Foscan-PDT. Twenty-five patients with squamous cell carcinoma (SCC) of the lip (Tis, T1, T2/N0/M0) and Karnofsky status > or = 70 received 0.15 mg/kg Foscan intravenously, followed 4 days later by a single non-thermal illumination of the tumour (light dose 20 J/cm2, irradiance 100 mW/cm2, lambda=652 nm). Response was determined after 12 weeks and mean follow up is 424 days so far. After 12 weeks, 96% of cases (24/25) showed CR, and all CRs were confirmed by biopsy. The most common adverse event was swelling and local pain at the treatment site. Tumour recurrence was observed in two patients 4 and 18 months after PDT. One patient developed a single lymph node metastasis 7 months after therapy. Photosensitivity reactions occurred in five patients. The functional results were excellent in all patients without any signs of limited mouth opening or impaired lip closure. The cosmetic outcome was better than after surgical therapy. Foscan-PDT is an effective treatment modality for small primary tumours of the lips. Foscan-PDT yields complete response rates comparable to those published for surgery or radiotherapy without causing major toxicity. It allows preservation of form and function and does not compromise future treatment options for recurrent, residual or second primary disease.     

Surgical margins for resection of squamous cell carcinoma of the lower lip

A prospective study was undertaken to evaluate the efficacy of 3 mm margins of resection with surgical excision of squamous cell carcinoma of the lower lip (SCCLL) in its early stages whereby the margins were checked with the systematic use of frozen-section examination. During the period of 1991-1998, 72 consecutive patients with a primary stage I/II SCCLL underwent surgical excision as the initial treatment. There were 58 males (81%) and 14 females (19%) with a median age of 66.8 years (range 37-91 years). The majority of cases (94.4%) were stage I tumours. Treatment consisted of a full-thickness excision including a 3 mm margin of clinically uninvolved tissue. Intraoperative frozen-section analysis of the margins of the excised specimen was used to confirm tumour-free margins. Clinically determined margins were tumour-free in 89.9% on initial excision. The false-positive rate associated with frozen-section analysis was 1.4%. The minimum follow-up period for all patients was 2 years (median 5.1 years, range 2-9 years). Local recurrence was found in two patients (2.8%). A 3 mm margin with excision of early SCCLL seems to be appropriate, if the margins are controlled by systematic use of frozen-section analysis.     

COX-2和唇癌血管生成相关性研究

目的：探讨环氧化酶-2（COX-2）表达与唇癌血管生成的关系。方法：免疫组化检测唇癌COX-2、诱导型一氧化氮合酶（iNOS）、血管内皮生长因子（VEGF）的表达,并测定肿瘤微血管密度（MVD）。结果：唇癌COX-2表达与VEGF、iNOS表达密切相关（P〈0．05）,唇癌COX-2表达阳性组和阴性组的MVD有显著差异（P〈0．01）。结论：COX-2表达和唇癌血管生成密切相关,iNOS和VEGF可能参与COX-2对肿瘤血管生成的促进作用。     

Oncologic aspects of vermilionectomy in microinvasive squamous cell carcinoma of the lower lip

Twelve patients with microinvasive squamous cell carcinoma of the lower lip were studied in order to determine whether vermilionectomy was justifiable. The maximum tumor thickness (MTT) varied between 1.1 and 3.1 mm. In none of the patients was there local recurrence during a mean follow-up period of 4.4 years (range 4–8). In view of these results and of what has been reported in the literature, it seems warranted to conclude that vermilionectomy is an appropriate procedure in microinvasive carcinoma of the lower lip with a MTT of up to 3 mm.     

The importance of stromal inflammation in squamous cell carcinoma of the tongue

J Oral Pathol Med (2012) 41 : 379–383 Background: Histological risk assessment evaluating worst pattern of tumour invasion (WPOI), and lymphocytic response (LR), has previously been shown to be of prognostic significance in squamous cell carcinomas of the head and neck (SCCHN). SCCHN is a heterogeneous group of tumours including tumours located in the oral cavity, of which the majority is located in the tongue. Methods: Haematoxylin/eosin–stained slides from diagnostic biopsies from 94 cases of SCC on the tongue were evaluated for WPOI and LR. Within the inflammatory infiltrate, the percentage of eosinophilic granulocytes was also estimated. Results were correlated with clinical data such as response to treatment and recurrence. Results: For WPOI the majority of patients, 84%, showed small invasive tumours islands with a size <15 cells (grade 4). No correlation with survival, response to treatment or recurrence was seen for WPOI. More than half of the patients showed a dense lymphocytic infiltrate, a factor that was significantly correlated with complete response to radio therapy. Of the patients with dense lymphoid infiltrate, the majority, 63%, did not either have a recurrence. No significant correlation with recurrence, response to treatment or any other factor was seen for presence of eosinophils. Conclusions: Data clearly showed that tongue tumours have a split invasive growth pattern and an intense inflammatory response at the tumour interface. Results also indicated that evaluation of the intensity of the inflammatory infiltrate at the tumour interface in tongue SCC could provide information of potential importance for choice of treatment and prognosis.     

Prognostic importance of site in squamous cell carcinoma of the buccal mucosa

While stage and grade of oral cancer have a profound and well-recognised influence on outcome, the effect of site is less clear and there have been relatively few published series that specifically address how site affects prognosis. Recent series have found that buccal cancers have a relatively poor prognosis compared with other sites, and suggest that this may be because the tumours are more aggressive. We examined 482 consecutive patients with oral cancers that had been operated on in a single unit, and report the presentation, treatment, and outcome of buccal tumours compared with those of other oral sites with reference to other prognostic variables. There were no significant differences between buccal and other cancers in patients’ characteristics, clinical presentation, or pathological staging, except in buccal tumours that rarely had pT1 stage (n = 13,16%) compared with other sites (n = 112, 28%, pT1-4, p = 0.02). Despite a higher rate of frankly involved margins (p = 0.02), the 5-year disease-specific survival was 70% for buccal tumours compared with 75% for other sites (p = 0.34). We conclude that site had little influence on prognosis, and that the poor outcome of buccal cancers reported from other centres has not been replicated in our series.     

应用快速冰冻活检确定唇癌手术边缘的研究

目的：评价快速冰冻活检在唇癌手术治疗中的意义。方法：分析168例经手术治疗的唇癌患者术中快速冰冻活检确认手术边缘的检查结果。手术边缘发现浸润癌或原位癌记为阳性边缘。结果：168例患者中有22例发现阳性边缘（13．10％）,168例中10例（5．95％）术后复发。结论：快速冰冻活检评估手术边缘是控制手术切除范围的可靠方法,可有效减少术后复发及术后放疗,但阴性手术边缘并不能保证术后的零复发率。     

Immunohistochemical expression of matrix metalloproteinases in squamous cell carcinoma of the tongue and lower lip

Objective

To evaluate the immunohistochemical expression of MMP-1, -2, -7, -9 and -26 in oral squamous cell carcinomas (SCCs) according to tumour site and histological grade of malignancy.

Study design

Fifteen cases of SCC of the lower lip and 15 cases of tongue SCC were selected and divided into low grade malignancy (n = 17) and high grade malignancy (n = 13).

Results

Higher immunohistochemical expression of MMPs by neoplastic cells was observed in tongue SCCs, with a statistically significant difference for MMP-9 (P < 0.05). High-grade SCCs showed a higher expression of MMPs, except for MMP-2, with a statistically significant difference for MMP-7 (P < 0.05) and MMP-26 (P < 0.05). In addition, a direct association was observed between morphological scores of malignancy and MMP immunoreactivity, with the association being significant for MMP-7 and MMP-26.

Conclusion

The present results demonstrate the important role of MMPs in the development of SCCs of the lower lip and tongue.