Actinic cheilitis: Proposal of a clinical index

Background: Actinic cheilitis is a potentially malignant lesion most commonly found in the lower lip of individuals with chronic exposure to ultraviolet radiation. The aim of this study was to develop and to test a clinical indexthat can be used to assess the severity of actinic cheilitis.Material and Methods: The clinical index of actinic cheilitis was applied to 36 patients. An incisional biopsy wasobtained to grade oral epithelial dysplasias following the World Health Organization (WHO) and binary systems,and to evaluate their association with clinical characteristics by Fisher’s exact test (P<0.05). The accuracy of theindex was evaluated based on sensitivity, specificity, positive and negative predictive values, and receiver operating curve.Results: The blurring between the border of the lip and the skin was significantly associated with cases withoutdysplasia/mild epithelial dysplasia (P=0.041) and with low risk of malignancy (P=0.005). Ulcers and crusts weresignificantly associated with moderate/severe epithelial dysplasia (P=0.002 and P=0.012, respectively) and highrisk of malignancy (P=0.005 and P=0.045, respectively). Erosion showed a significant association only with highrisk cases of malignancy (P=0.024). The cut-off values of the diagnostic test showing the best performance were10 for the WHO grading system and 11 for the binary system.Conclusions: The index cut-offs with the highest accuracy were considered indicators for a biopsy. Erosion, ulceration and crusts were associated with more severe oral epithelial dysplasias. (AU)

Colgajo en isla del labio superior: claves fundamentales y serie de casos / Island Flap for Upper-Lip Reconstruction: Analysis of Key Aspects and a Case Series

La reconstrucción del labio superior tras la cirugía de Mohs supone, en ocasiones, un reto para el cirujano dermatológico. Presentamos una serie de 15 pacientes (7 hombres y 8 mujeres; edad media de 65,6 años) con cáncer cutáneo (10 carcinomas basocelulares, 2 melanomas y 3 carcinomas escamosos) localizados en el labio superior intervenidos mediante cirugía de Mohs con defectos resultantes de 3-7,6 cm. Para la reconstrucción se empleó un colgajo en isla del labio superior diseñado escondiendo las incisiones en el pliegue nasolabial, en la línea de unión del bermellón con la piel y en las líneas de tensión de la piel relajada. Se explican las claves del diseño y la cirugía, enfatizando en la importancia de sacrificar en ocasiones pequeñas zonas de tejido sano. Se alcanzaron resultados satisfactorios cosméticos y funcionales, sin complicaciones posquirúrgicas en todos los pacientes

Upper-lip reconstruction after Mohs micrographic surgery is challenging for dermatologic surgeons. We describe a series of 15 patients (7 men and 8 women; mean age, 65.6 years) with skin cancer on the upper lip treated with Mohs surgery: 10 were basal cell carcinomas, 2 were melanomas, and 3 were squamous cell carcinomas. The resulting defects measured between 3 and 7.6cm. We used island flaps to reconstruct the defects in all cases, hiding the incisions in the nasolabial fold, at the line where the skin meets the vermillion border of the lip, and in the relaxed skin tension lines. We explain key aspects of the surgeries and design of the reconstructions, with emphasis on the importance of occasionally sacrificing small areas of healthy skin. Cosmetic and functional outcomes were satisfactory in all patients, and there were no postsurgical complications

Tumors of the labial mucosa: a retrospective study of 1045 biopsies

BACKGROUND: To investigate the relative frequency of localized mucosal swellings of the upper and lower labial mucosa, the clinical-pathological diagnosis agreement and whether patient's age and gender and tumor's site and size may raise the suspicion of neoplasm. MATERIAL AND METHODS: Retrospective analysis was performed on upper or lower labial mucosal tumors, histopathologically diagnosed between 2009-2018. The diagnostic categories developmental/reactive tumors, benign and malignant neoplasms were associated with patient's age and gender and tumor's site and size; clinical-pathological diagnosis agreement was, also, evaluated. RESULTS: Overall, 1000 (95.7%) developmental/reactive tumors, 35 (3.3%) benign and 10 (1%) malignant neoplasms were found. Upper/lower lip tumor ratio was 0.14:1. The diagnostic category was significantly associated with age (p < 0.0001), site (p < 0.0001) and diameter (p < 0.0001). Age ≥60 years, tumor's location on the upper lip and diameter >1cm were independent predictors for neoplasms. Patients presenting 2 or 3 of these variables were 20.2 times (p < 0.0001) or 33.6 times (p < 0.0001), respectively, more likely to have a neoplasm. Complete/partial agreement between clinical and pathological diagnosis was seen in 96.3% of the cases. CONCLUSIONS: Most lip tumors involve the lower lip and are reactive, but upper lip tumors measuring > 1 cm in patients ≥ 60 years have significantly higher probability to be neoplasms

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Terapia fotodinámica con luz de día en el tratamiento de la queilitis actínica / Actinic Cheilitis Treated With Daylight Photodynamic Therapy

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Can immunohistochemical biomarkers distinguish epithelial dysplasia degrees in actinic cheilitis? A systematic review and meta-analysis

BACKGROUND: Actinic cheilitis (AC) is a potentially malignant disorder of the lip, characterized by epithelial and connective tissue alterations caused by chronic exposure to ultraviolet radiation. In the past decades, diverse studies have been conducted in lip carcinogenesis and many biomarkers have been identified in lip lesions, yet there is no scientific evidence that determines its usefulness in the clinical setting or in histopathological routine. Therefore, we conducted the first systematic review in this field to summarize the results of published studies on immunohistochemical biomarkers in lip carcinogenesis, to evaluate if there is a marker than can distinguish the different histological grades of AC. MATERIAL AND METHODS: Retrospective studies that investigated immunohistochemical biomarkers in AC defined on standardised histological assessment were gathered from five databases and evaluated. Each study was quali-tatively evaluated using the Critical Appraisal Tools from SUMARI. RESULTS: The proliferation marker Ki-67 was the most studied biomarker and we observed, through meta-analysis, that it was differently expressed between AC and lip cancer, but not in AC subgroups. Most articles had a high risk of bias. CONCLUSIONS: In summary, the literature lacks quality follow up studies in actinic cheilitis. Multi-centre cohort studies, with patients stratified by treatment type and the use of image analysis software, could be the solution to further address the issues of investigating potentially malignant lesions and help change clinical practice, in terms of individualizing patients' treatment and prognosis prediction

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Sialolitiasis en glándula saliva menor: a propósito de un caso / Sialolithiasis of minor salivary gland: a case report

La sialolitiasis es la segunda patología más prevalente de las glándulas salivares, representando el 30% de la patología salival. La localización más frecuente es en la glándula submandibular, con alrededor del 80% de los casos de litiasis, mientras que la afectación de las glándulas salivares menores es de aproximadamente un 2%. La etiopatogenia de esta entidad sigue siendo un tema controvertido, sin embargo se atribuyen factores bioquímicos, infecciosos y mecánicos como los causantes de su formación. Una adecuada exploración física acompañada de la realización de pruebas complementarias de imagen, como la ecografía, resonancia magnética (RM) o tomografía computerizada (TC), serán fundamentales para el diagnóstico de la lesión. Se presenta el caso clínico de una paciente con diagnóstico de sialolitiasis de glándula salival menor labial tratada quirúrgicamente así como los resultados de la revisión científica bibliográfica hecha al respecto

Sialolithiasis is the second most frequent disease of the salivary glands, representing the 30% of whole salivary pathology. The most prevalent localization occurs in the submandibular gland, affected in 80% of cases of lithiasis, whereas minor salivary glands are concerned only in 2%. The etiology of this entity is still controversial, however different biochemical, infectious and mechanics factors have been attributed as the source of its formation. A correct physic examination along with supplementary images tests, as ultrasound, MRI or CT scan, will be essential for the right diagnosis. A case of a female diagnosed with sialolithiasis of minor salivary gland and surgically treated within a review of the literature is described

Cierre de grandes defectos en el labio inferior. Combinación: colgajo de Karapandzic y colgajo de deslizamiento contralateral / Closure of Large Lower Lip Defects: Combining a Karapandzic Flap and a Contralateral Sliding Flap

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Lower lip squamous cell carcinoma in patients with photosensitive disorders: Analysis of cases treated at the Brazilian National Cancer Institute (INCA) from 1999 to 2012

Background: Lower lip squamous cell carcinoma (LLSCC) is a common malignancy of the head and neck, being mainly a consequence of a chronic exposure to ultraviolet (UV) light solar radiation. Here, we evaluated the clinicopathological profile of patients with photosensitive disorders (xeroderma pigmentosum, lupus erythematosus and albinism) that developed LLSCC. Material and Methods: Data from patients who had a diagnosed LLSCC with a prior xeroderma pigmentosum, lupus erythematosus or albinism diagnosis that were treated at INCA from 1999 to 2012 were collected from patients' medical records (n=16). The control group was composed of 68 patients with LLSCC without a medical history of photosensitivity. The clinicopathological data of this study population were collected and the association between these variables was analyzed by Fisher's exact test. Survival curves were constructed using the Kaplan-Meier method and compared by log-rank test. All statistical analyses were performed using SPSS statistics package. Results: The mean age of patients in the photosensitive and non-photosensitive groups was 42 years and 67 years, respectively (p<0.0001). A previous history of malignant diseases was more common in the photosensitive group (p=0.001). In both groups, most tumors showed a pathological stage I/II disease. Overall and cancer-specific survival were not statistically different. However, disease-free interval showed a significant difference (p=0.01) between the photosensitive and non-photosensitive patients. Conclusions: Photosensitive patients presented LLSCC at earlier age but it usually was not the primary tumor in these patients. Furthermore, a more aggressive pathological behavior was not seen when compared with tumors from non-photosensitive patients. The disease-free interval was lower in photosensitive patients, as expected (AU)

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Carcinoma espinocelular manifestado como cuerno cutáneo que simula un pico de pájaro / Squamous cell carcinoma presenting as bird beak-like cutaneous horn

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Evolución de la incidencia del cáncer de piel y labio durante el periodo 1978-2007 / Changes in the Incidence of Skin and Lip Cancer Between 1978 and 2007

Introducción: El objetivo del estudio es analizar la tendencia temporal en la incidencia del cáncer de piel a nivel mundial, europeo y español durante el período comprendido entre 1978-2007. Material y métodos: Se estudiaron la incidencia y la tendencia del cáncer de piel en el período 1978-2007 a través de la publicación Cancer Incidence in Five Continents usando las tasas estandarizadas por edad y sexo por 100.000 habitantes. Resultados: La incidencia del melanoma cutáneo ha aumentado desde 1978 a 2002, pero en el último periodo 2003-2007 disminuye a nivel mundial. Las incidencias máximas se registraron en Australia y en la población de raza blanca de Hawaii. En España la incidencia de melanoma se triplicó en ambos sexos al final del período. La incidencia del cáncer cutáneo no melanoma aumentó durante el período de estudio (1978-2007), con tasas más elevadas en varones. Las incidencias máximas se registraron en Australia, Brasil y en la población europea de Zimbabue. En España la incidencia de cáncer cutáneo no melanoma llegó a duplicarse o triplicarse en ambos sexos al final del período. Limitaciones: No se ha podido analizar el período más actual 2008-2012 debido a un retraso de 5 años en la publicación de los datos por parte del IARC. Conclusiones: El aumento de la incidencia del cáncer de piel ajustando por los cambios en el envejecimiento de la población sugiere que las medidas de prevención primaria son insuficientes o inadecuadas. La disminución de la incidencia de melanoma en Australia en el último período apoya la eficacia de medidas de prevención iniciadas hace varias décadas (AU)

Introduction: The aim of this study was to analyze trends in the incidence of skin cancer worldwide, in Europe, and in Spain between 1978 and 2007. Material and methods: Skin cancer incidence and trends for the period 1978 to 2007 were investigated using the age- and sex-standardized rates (per 100,000 population) published in the Cancer Incidence in Five Continents series. Results: The incidence of cutaneous melanoma increased progressively from 1978 to 2002 but decreased in the last period analyzed (2003-2007). The highest rates were reported for Australia and the white population in Hawaii. In Spain, the incidence of melanoma tripled in both sexes over the study period. The incidence of nonmelanoma skin cancer also increased between 1978 and 2007, and higher rates were detected in men. The highest incidence rates were recorded in Australia, Brazil, and among the European inhabitants of Zimbabwe. In Spain, the incidence of nonmelanoma skin cancer had doubled or tripled in both sexes by the end of the study period. Limitations: We were unable to analyze data for the period 2008 to 2012 due to a 5-year delay in the publication of data by the International Agency for Research on Cancer. Conclusions: The rise in the incidence of skin cancer, assessed using age-standardized rates, suggests that primary prevention measures are insufficient or inappropriate. The reduction in the incidence of cutaneous melanoma in Australia between 2003 and 2007 suggests that the preventive strategies initiated several decades earlier in that country have been effective (AU)

Braquiterapia de alta tasa en el carcinoma escamoso de labio en estadios iniciales / High dose rate brachytherapy in early stage squamous-cell carcinoma of the lip

Introducción y objetivos: Analizar los resultados obtenidos en el tratamiento del carcinoma escamoso de labio en estadios iniciales (T1-T2) con braquiterapia de alta tasa y evaluar la eficacia para el control local y regional de dicho tratamiento. Material y métodos: Análisis retrospectivo de los tratamientos realizados entre marzo de 1999 y marzo de 2013 con braquiterapia de alta tasa de dosis con agujas rígidas, a 68 pacientes, 63 varones y 5 mujeres. Treinta y siete pacientes (54,4%) presentaban un tumor igual o menor de 2cm (T1), y 31 (45,6%) de 2-4cm (T2). En todos se indicó braquiterapia radical con una dosis total mediana de 45Gy, con una dosis por fracción de 5Gy x 9 fracciones, dos veces al día, en un ingreso de cinco días. Resultados: Con 56,4 meses de seguimiento medio el control local fue 96,9%. En pacientes con tumores T1 el control local fue del 100%, mientras en T2 fue 93,2% (2 recidivas locales). El control regional a 5 años, en T1 fue 93,8% y en T2 80,8%. En once casos con profilaxis cervical no hubo recaídas. En cuanto a toxicidad, ningún paciente presentó necrosis de tejidos blandos ni ósea y en todos ellos se consiguieron resultados cosméticos y funcionales buenos o excelentes. Conclusiones: La braquiterapia de alta tasa permite realizar métodos seguros y efectivos para tratamiento del carcinoma escamoso de labio, con buenos resultados estéticos y funcionales y mínimas complicaciones y puede considerarse una alternativa válida al tratamiento quirúrgico en estadios iniciales (AU)

Introduction and goals: To analyze the results obtained after treatment of early stage (T1-T2) squamous cell carcinoma of the lip with high dose rate brachytherapy and evaluate the efficacy of this treatment in both local and regional control. Materials and methods: Retrospective analysis of the treatments performed at our department from March 1999 to March 2013 with high dose rate brachytherapy with rigid needles. We included 68 patients, 63 men and 5 women; 37 patients (54.4%) presented a T1 tumour, less than or equal to 2cm, while the other 31 (45.6%) were classified as T2. Median total dose was 45Gy, with a median dose per fraction of 5Gy x 9 fractions twice a day for 5 days. Results: With a mean follow-up of 56.4 months, local control was 96.9%. Stratifying by tumour size, local control of T1 cases was 100%, while T2 achieved 93.2% (2 local recurrences). Regional control at 5 years was 93.8% for T1, and 80.8% for T2. In 11 cases with elective cervical treatment, no regional failure happened. As for toxicity, no patient presented soft tissue, or bone, necrosis. All patients achieved good or excellent cosmetic and functional results. Conclusions: High dose rate brachytherapy allows effective, safe treatments for squamous cell carcinoma of the lip, with good aesthetic and functional results. It can be considered a valid alternative for surgery in early stage tumours (AU)

Guidance flap choice for lip cancer: Principles, timing and esthetic-functional results / Guía para la elección del colgajo en el cáncer de labio: principios, tiempos, resultados estéticos y funcionales

The purpose of this study is to help in the choice of an appropriate reconstructive technique by reference to the dimensions of the defect, the required functional and esthetic outcomes, and retention of adequate surgical safety margins to prevent primary tumor recurrence. Material and methods. A total of 158 patients were treated. We indicate how the most appropriate reconstructive method may be chosen, with reference to the size and position of the cancer and depth of tissue infiltration. Result. Of all patients, 89 (56.3%) had T1 (lesions up to 2 cm long, less than 1/3). The remaining patients had T2 lesions >2 cm, from 1/3 to 2/3 of lip involvement (50 patients), T3 lesions >4 cm, more than 2/3 of lip involvement (18), and a T4 lesion > 5.5 cm with commissure involvement (1). Conclusion. We share the widespread view that a surgeon who performs a reconstruction using the minimal tissue components required to close the lesion will achieve the best results. Reconstruction does not influence prognosis and overall should be oriented to the defect. Careful, clean, and safe resection of lip carcinoma, with creation of healthy margins, can be followed by functional and esthetic lip reconstruction (AU)

El objetivo de este estudio es orientar al cirujano en la correcta elección de una técnica reconstructiva según la dimensión del defecto, de los resultados estéticos-funcionales necesarios y tendente a conservar los margenes quirúrgicos de seguridad indispensables para prevenir la recidiva del tumor primitivo. Materiales y métodos. Analizaremos los casos de cáncer de labio tratados en 158 pacientes, indicaremos el método apropiado para la reconstrucción con referencia a la dimensión y localización del cáncer, y a la profundidad del tejido infiltrado. Resultados. De todos los pacientes que hemos analizado, 89 (56,3%) pertenecían al grupo clasificado como T1 (lesiones hasta 2 cm de largo, menos de 1/3 del labio implicado), 50 pacientes pertenecían al grupo T2 (lesiones > 2 cm, desde 1/3 hasta 2/3 del labio involucrado), 18 pacientes pertenecían al grupo T3 (lesiones > 4 cm, más de 2/3 de labio implicado) y un paciente pertenecía al grupo T4 (lesiones > 5,5 cm, con la comisura incluida). Conclusión. Coincidimos con la idea de que el cirujano reconstruye utilizando la cantidad mínima de tejido para corregir la deformidad y obtener los mejores resultados, pero la reconstrucción no puede influir en el pronóstico, solo debe orientar el tipo de defecto. Una extirpación segura de el tumor del labio, meticulosa, con el mantenimiento de los márgenes sanos, debe ser complementada con una cirugía reconstructiva del labio en su totalidad, es decir, en toda su estética y su funcionalidad (AU)

Intradermal Lipoblastoma-Like Tumor of the Lip in an Adult Woman / Lipoblastoma intradérmico tumor tipo en el labio de una mujer adulta

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Reconstrucción de defectos quirúrgicos en la comisura oral / Reconstruction of Surgical Defects of the Labial Commissure

La misión principal de la cirugía dermatológica oncológica es la extirpación completa del tumor cutáneo. Tras ello se procederá a la reconstrucción del defecto intentando preservar la funcionalidad y la estética. Al nivel de las comisuras se entrecruzan las fibras del músculo orbicular de los labios superior e inferior, y el bermellón se inserta en el modiolo, una compleja estructura con forma de cono. La reconstrucción de la comisura oral supone un reto quirúrgico, ya que hemos de respetar la función esfinteriana y la simetría. Presentamos varios casos de defectos quirúrgicos situados en la comisura bucal y la solución reconstructiva por la que optamos, así como una propuesta de algoritmo reconstructivo

The main objective of oncologic dermatologic surgery is the complete excision of skin tumors. During reconstruction of the defect, we must attempt to preserve function and cosmetic appearance. At the labial commissure, fibers from the superior and inferior portions of the orbicularis oris muscle intersect and the vermillion inserts onto the modiolus, a complex, cone-shaped structure at the angle of the mouth. Surgical reconstruction of the labial commissure is challenging because of the need to preserve sphincter function and cosmetic symmetry. We present a number of cases of surgical defects at the labial commissure and describe the reconstruction techniques used. We also propose an algorithm to help determine the most suitable technique for different cases

Empleo de la terapiafotodinámica en el tratamiento de la queilitis actínica / Use of photodynamic therapy in the treatment of actinic cheilitis

La queilitis actínica, enfermedad común del labio causada por la exposición solar crónica, es una lesión premaligna con la capacidad de transformarse en carcinoma de células escamosas. El diagnóstico y tratamiento temprano y efectivo dela lesión es importante. La crioterapia, quimioterapia tópica, inmunomodulación y extirpación quirúrgica se han propuesto como intervenciones terapéuticas. Algunos de los tratamientos disponibles son invasivos, tienen resultados poco estéticos y requieren varias sesiones. Se revisaron 11 artículos publicados en los últimos años sobre el uso de la terapia fotodinámica como tratamiento de la queilitis actínica. La terapia fotodinámica se ha introducido como una modalidad terapéutica para los tumores de la piel obteniendo buenos resultados estéticos. La terapia fotodinámica es eficaz en el tratamiento de la queilitis actínica. El análisis histopatológico de la lesión es fundamental. La limitación en la exposición solar del labio es esencial para prevenir su aparición. Son necesarios estudios a largo plazo para la evaluación de las recidivas y definir el número ideal de sesiones para tratar de forma eficaz estas lesiones

Actinic cheilitis, a common disease of the lipcaused by chronic solar exposure, is a premalignant lesion with the capacity of transforming into squamous cell carcinoma. The early and effective diagnosis and treatment of the lesion is important. Cryotherapy, topical chemotherapy, immunomodulation and surgical extirpation have been proposed as therapeutic interventions. Some of thetreatments available are invasive, have antaesthetic results and require various sessions. Eleven articles were reviewed, published in recent years on the use of photodynamic therapy as a treatment for actiniccheilitis. Photodynamic therapy has been introduced as a therapeutic modality for skin tumours obtaining good aesthetic results. Photodynamic therapy is effective in the treatment of actinic cheilits. The histopathological analysis of the lesion is basic. The limitation of sun exposure on the lip is essential in preventing its appearance. Long-term studies are necessary for the evaluation of the recurrences and for defining the ideal number of sessions in order to treat these lesions effectively

Comparison of two different labial salivary gland biopsy incision techniques: A randomized clinical trial

Objectives: To compare the reliability of two different labial salivary gland biopsy (LSGB) incision techniques (vertical versus horizontal incision techniques) and to report the related complications and discomfort. Study Design: 163 patients who underwent LSGB were included in this study. Patients were randomly divided as vertical incision group (n=81) and horizontal incision group (n=82). Demographic and clinical information of each patient were recorded. A questionnaire was prepared and applied together with Visual Analog Scale (VAS) on the subjects verbally at the 7th day, postoperatively. Intraoperative, short- term and delayed complications were evaluated. Results: The mean age of patients (117 female, 46 male) was 47.3 years (range 19-79 years). Vertical incision technique was associated with less pain (p<0.001), less swelling (p<0.05), less scar formation (p<0.05) and less difficulty in eating (p<0.05) when compared with horizontal incision technique. No statistically significant differences were observed between the 2 groups in terms of hematoma, parasthesia and speech difficulty (p>0.05). Additionally, two subjects in the horizontal incision group revealed permanent paresthesia during the follow-up period of two years. Conclusions: This prospective study demonstrated that the subjects in the vertical incision group had less complication rates and discomfort after labial salivary gland procedure than those in the horizontal incision group (AU)

Upper lip malignant neoplasms. A study of 59 cases

Objectives: To present the demographic data, clinico-pathologic features and therapeutic outcome of a series of upper lip malignancies. Study Design: Retrospective study at a single Cancer Institution in Mexico City during a 14-year period. Results: There were 59 cases, (30 males and 29 females); age range: 14 to 106 years (mean: 73 yr.). Antecedents of ultraviolet light and tobacco exposure were found in 20 (33.9%) and 16 cases (27%) respectively. There were 35 squamous cell carcinomas (59.3%), 19 basal cell carcinomas (32.2%) and one case each (1.7%) of adenocarcinoma NOS, adenoid cystic carcinoma, angiosarcoma, Merkel cell carcinoma and melanoma. There were 14 cases in stage I (23.7%), 14 in stage II (23.7%), 3 in stage III (5.1%) 14 in stage IV (23.7%) and 14 were not classified (23.7%). There were no significant differences with respect to the overall survival curve and the disease-free survival curve among surgical treatment and radiotherapy. In addition, there was not statistically significant difference in the overall survival and disease-free survival among squamous cell carcinoma and basal cell carcinoma cases with respect to the type of treatment. Conclusions: Upper lip malignant neoplasms are infrequent lesions. The present series describes the main clinicopathological features in a hospital-based population in Mexico city and demonstrates some differences with respect to those found in the lower lip (AU)

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