A, Vermilion borders were determined via skin marker. B, Modified vermilionectomy with partial orbicularis oris muscle. C, Excision material with ruler (6×1 cm). D, A view of the reconstructed lower lip immediately after closure with polypropylene suture.
A, Determination of the vermilion borders and the extension of the lesion with skin marker. Excision borders were also determined. B, Vermilionectomy was applied prior to wedge resection. C, Excision material could be seen and the right surgical edge was marked by suture. D, Polypropylene sutures were used to close both vermilionectomy and wedge resection defect.
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Kaya I, Uslu M, Ozturk A, Apaydin F. Long-term Results of Vermilionectomy in Malignant and Premalignant Lower Lip Lesions. JAMA Facial Plast Surg. 2018;20(3):253–254. doi:https://doi.org/10.1001/jamafacial.2017.1878
Most squamous cell carcinomas (SCCs) of the lower lip develop after actinic cheilitis (AC).1 Therefore, appropriate and efficient treatment of AC is important to prevent invasive carcinoma development. Vermilionectomy is a safe and effective option in the treatment of premalignant lesions such as AC, even in microinvasive SCC, owing to its easy application and excellent cosmetic results.2,3 We aimed to investigate the effectiveness of vermilionectomy and wedge resection in SCC and AC of the lower lip.
This study was approved by the ethics committee of Ege University where this study was conducted. Because this is a retrospective study, informed consent was not obtained from patients, but waiver was granted by the ethics committee of Ege University.
Ninety-four patients of 168 who had regular follow-up between 2005 and 2015 were retrospectively analyzed. Patients were excluded who had 1 year or shorter follow-up time.
A classic vermilionectomy was carried out in 38 patients, and modified vermilionectomy with the partial resection of the orbicularis oris muscle was performed in 19 patients where the lesion was a bit deeper or minimally invaded the muscle. After vermilionectomy, reconstruction was performed with mucosal advancement flap in all patients (Figure 1). The patients with SCC underwent simultaneous V-shaped wedge resection (Figure 2). All patients were followed up every 3 months for at least 1 year.
Of the 94 participants, 23 (24%) were women and 71 (76%) were men. Mean age was 64 years (range, 35-99 years). Mean follow-up period was 68 months (range, 16-126 months). Preoperative biopsy results showed AC alone in 55 (58.5%) and SCC in 39 (41.5%) patients. Postoperative biopsy findings revealed SCC accompanying AC in 14 (25%) patients, SCC in situ in 4 patients in the AC-only group. All patients with SCC had T1 tumors (maximum tumor size, 1.4 cm). Six patients died during follow-up owing to other comorbidities.
Local recurrence was observed in 2 (5%) patients with SCC. Invasive carcinoma was not seen in any of the AC-only patients. In 3 patients dehiscence was observed and 11 patients had paresthesia as well.
Lower lip cancers have a 5% to 20% recurrence rate.4 In this study, local recurrence was observed in 2 patients (5%) in the SCC group. Recurrences may have been treated elsewhere, which may be a reason for lack of follow-up. A total of 64 patients were excluded owing to the lack of follow-up.
Vermilionectomy is very efficient in the treatment of AC. It can also be used in the treatment of early-stage SCC; however, it may not be enough alone in patients with lesions that involve the muscle and deeper tissues. In these patients, vermilionectomy can be modified or wedge resection should be performed. Although preoperative biopsy findings revealed AC in 55 patients, in 19 patients modified vermilionectomy was carried out owing to deeper involvement. In this group postoperative biopsy findings revealed SCC in 15 (25%) patients. Ackerman et al5 indicated that AC to SCC conversion was 10.2%, but they also stated that, in fact, AC is SCC. Thus, AC to SCC conversion is only a matter of time. High rates of preoperative and postoperative inconsistency of the histopathological AC to SCC diagnosis in our study might be related to inappropriate biopsy materials or more likely to high rates of AC to SCC conversion and accompanying SCC. Recurrence or invasive carcinoma development were not observed in any of these patients. It suggests that modification of vermilionectomy can be performed efficiently in patients with superficially located SCC and that it is an effective method to prevent possible transformation to malignant disease. Nevertheless wedge resection could be an option for the treatment of biopsy-proven SCC of the lower lip.
Our study has some limitations. Retrospective design is the most important limitation of the study. The lack of follow-up and uncertainty of the prognosis in the excluded patients are the other limitations.
Vermilionectomy is a preferable option in the treatment of the AC and superficial SCC, which also prevents malignant transformation of the AC to SCC. In addition it has low complication rates.
Corresponding Author: Mustafa Uslu, Ege Universitesi Hastanesi Kulak Burun Bogaz Anabilim Dali, Bornova 35100, Izmir, Turkey (firstname.lastname@example.org),
Accepted for Publication: August 21, 2017.
Published Online: December 14, 2017. doi:10.1001/jamafacial.2017.1878
Author Contributions: Drs Uslu and Kaya had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: All authors.
Acquisition, analysis, or interpretation of data: Kaya, Ozturk, Apaydin.
Drafting of the manuscript: All authors.
Critical revision of the manuscript for important intellectual content: Kaya, Ozturk.
Statistical analysis: Kaya, Ozturk.
Obtained funding: Kaya, Ozturk.
Administrative, technical, or material support: All authors.
Study supervision: Apaydin.
Conflict of Interest Disclosures: None reported.
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