A man in his thirties with lifelong h/o severe actinic cheilitis of left lower lip. Recurrent flare-ups of cheilitis have been treated as recurrent herpetic infection. Recently he has experienced worsening of cheilitis and appearance of the lesion. Biopsy found squamous cell carcinoma with perineural invasion. Lip invasion was histologically measured to be > 2mm in depth potentially indicating higher risk of metastases.Discussion was held regarding the possible spread of cancer along the mental nerve and possible cervical lymphatic metastases. Sentinel lymph node biopsy as a diagnostic modality was discussed.
Mohs excision is planned at SCARS Center, where additional resection will be considered based on Mohs histology findings. Additional resection could involve greater tissue margin resection and possible mental nerve resection to treat perineural invasion skip areas. Post-operative radiation therapy can be considered but must be applied with caution given the patient’s young age.
CT/PET scan should be strongly considered in 3-6 months post-treatment.