28/01/2023
The patient presented to our clinic with a chief complaint of an ulcer on the lower lip for 15 days. On examination, we noticed a solitary, ulcerative, non-healing ulcer on the left side of the lower lip with an indurated base and rolled out margins, which are characteristic features of oral malignancy. Submental lymph nodes were palpable but not tender. Clinically, we gave a diagnosis of oral malignancy and advised for a biopsy to confirm the provisional diagnosis. An incisional biopsy was performed of the lower lip, and the histopath report H&E stained section revealed an intact superficial epithelium, which is a stratified squamous epithelium. The stroma is comprised of small strands and chords of dysplastic epithelial cells, which show individual cell keratinization, cellular pleomorphism, nuclear hyperchromatism, altered NC ratio, and a few mitotic figures (3-4/HPF). The surrounding stroma is composed of dense chronic inflammatory cell infiltrate, collagen fiber bundles, and numerous small and large capillaries. The histopathologic report gave a diagnosis of moderately differentiated squamous cell carcinoma of the lower lip (Grade II). After the final diagnosis, we advised for a contrast CT scan of neck to evaluate the extent of the disease. The CT scan revealed focal irregular soft tissue thickening involving the left buccal mucosa in the anterior aspect of the lower lip measuring 2 x 0.9 cm, mild thickening of the adjacent inferior gingivobuccal sulcus, mild diffuse edema seen in the midline lower lip, and mild thickening and irregularity of the overlying skin. There was no evidence of any extension to the retromolar trigone, masticator space/infratemporal fossa, or bony invasion. A prominent submental lymph node measuring 10mm and a subcentimetric left submandibular lymph node were also seen. After all primary investigations, the patient underwent surgery under general anesthesia, which included a wide local excision of the lower lip lesion and cervical lymph nodes of levels I to IV, followed by reconstruction of the lesion using a nasolabial flap. The wound was closed in layers.
