Dermatológia pre prax 4/2024

Surgical treatment of skin tumors of the lip

Purpose: The lips represent the most important functional and aesthetic anatomical structures of the lower segment of the face. Reconstruction of full-thickness defects after excision of carcinomas is crucial for restoration of oral integrity. The authors offer a simplification of the necessary decision-making reconstruction process based on the location and size of the lip defect. Patients and methods: This prospective study includes 49 patients who, between January 1, 2019, and December 31, 2023, underwent reconstruction of the upper or lower lip after carcinoma excision at the Department of Plastic, Reconstructive, and Aesthetic Surgery at the Louis Pasteur University Hospital in Košice. The localization and evaluation of the percentage extent of the lip defect conditioned the choice of a suitable surgical technique. Results: The cohort included patients aged 49 to 96 (mean age 77.9 years). We mainly detected basal cell carcinoma (70 %) in the upper lip, which dominated squamous cell carcinoma (30 %). In the lower lip, we observed an opposite prevalence in favor of squamous cell carcinoma (76.92 %) compared to basal cell carcinoma (20.51 %). In four patients (8.16 %), the area of the defect was 1.3 cm2 (up to 30 %), 35 patients (71.42 %) had a defect measuring 2.35 cm2 (30 — 80 %), and the remaining eight patients (16.32 %) had a subtotal to total lip defect measuring 4.14 cm2 (more than 80 % of the horizontal lip dimension). Tumor size and risk histological subtype were associated with developing a more significant defect. Postoperatively, we observed common complications, which did not determine the success of the reconstruction. The methods yielded excellent functional and aesthetic results with minimal patient discomfort. Conclusion: A significant group in the set consisted of patients with a defect more extensive than one-third of the lip (87.75 %). Functional and aesthetic preservation is more difficult for these defects and requires reconstruction with flaps with extended operating time. Therefore, the choice of reconstruction technique must be individualized for a specific patient.

Keywords: reconstruction, lip, flap, defect, carcinoma