Management of patients with squamous cell carcinoma of the lower lip and N0-neck

Aim: For lower lip carcinoma, an incidence of 15% of cervical lymph node metastasis at presentation is generally accepted. This is an argument in favour of an expectant approach. The purpose of this study was to compare the results of the different approaches to the clinically negative neck: prophylactic neck dissection, prophylactic neck irradiation and follow-up. Material and method: The retrospective study included 200 patients with lower lip carcinoma. The following data were evaluated: (1) the incidence of cervical lymph node metastasis in patients with a clinically negative neck; and (2) pathological confirmation of cervical lymph node metastasis. Results: In the group undergoing prophylactic neck dissection, lymph node metastasis was found microscopically in 20% of the cases. More than half of the patients receiving prophylactic radiotherapy developed bulky neck lymph node metastases. Out of the patients attending the 2-year follow-up 64% developed a clinically positive neck. Cervical lymph node metastases in these patients was proven microscopically in 88% of cases. Conclusion: The high incidence of a clinically positive neck, along with the high incidence of neck node metastasis found in neck dissection specimens suggest that elective neck dissection is the treatment of choice for the neck in patients with lower lip carcinoma. (C) 2003 European Association for Cranio-Maxillofacial Surgery.