89-year-old man presents with several month history of lesion on bottom lip. A biopsy was taken on 8-9-17 and showed severe squamous atypia without ruling out deeper SCC. Excision of lesion done 9-6-17 showed invasive squamous cell carcinoma with foci of moderate squamous dysplasia from 9 to 3 o’clock. Patient has history of BCC, SCC, and melanoma in situ.
Chasing margins of dysplasia on the chronically sun-damaged lower lip is not recommended. Treatment to be considered includes 5-fluorouracil cream, topical imiquimod, cryoablation, CO2 laser ablation, or photodynamic therapy. In this elderly man, observation was chosen.