Dermatologica Sinica

CASE REPORT
Year
: 2019  |  Volume : 37  |  Issue : 1  |  Page : 53--55

Pigmented basal-cell carcinoma of the upper lip: A report of a case and review of the literature


Natsuko Matsumura1, Anna Furukawa2, Kazuki Ueda2, Akihiko Oyama2, Toshiyuki Yamamoto1,  
1 Department of Dermatology, Fukushima Medical University, Fukushima, Japan
2 Department of Plastic and Reconstructive Surgery, Fukushima Medical University, Fukushima, Japan

Correspondence Address:
Natsuko Matsumura
Department of Dermatology, Fukushima Medical University, Hikarigaoka 1, Fukushima 960-1295
Japan

Abstract

Basal-cell carcinoma (BCC) rarely occurs on the lip. We herein report a case of an 89-year-old male, who presented with a blackish nodule on the vermilion border and the outer mucosa of the right side of the upper lip. A diagnosis of pigmented BCC was made by histopathological examination. The patient was successfully treated by Abbe flap with excellent esthetic and functional results. We have reviewed 64 cases of lip BCCs previously reported. There was no gender predominance, and the upper lip was involved 1.5 times higher than the lower lip. There was no lymph node metastasis, and thus, lip BCC had a good prognosis.



How to cite this article:
Matsumura N, Furukawa A, Ueda K, Oyama A, Yamamoto T. Pigmented basal-cell carcinoma of the upper lip: A report of a case and review of the literature.Dermatol Sin 2019;37:53-55


How to cite this URL:
Matsumura N, Furukawa A, Ueda K, Oyama A, Yamamoto T. Pigmented basal-cell carcinoma of the upper lip: A report of a case and review of the literature. Dermatol Sin [serial online] 2019 [cited 2019 Sep 15 ];37:53-55
Available from: http://www.dermsinica.org/text.asp?2019/37/1/53/255034


Full Text



 Introduction



Basal-cell carcinoma (BCC) is one of the most common skin cancers. In general, it occurs mostly in the central region of the face, where sun exposure is pronounced. From this reason, ultraviolet rays are thought to be the main factor in the development of BCC. We herein describe a case of pigmented BCC on the lip of an elderly person and also reviewed previous reports on labial BCC.

 Case Report



An 89-year-old Japanese male visited our department, complaining of a small nodule on the upper lip, which appeared 2 years previously. He had a history of cerebral infarction and had received warfarin and anticoagulation therapy. The patient's family history was noncontributory. Physical examination revealed a 6 mm × 4 mm, irregular-shaped, slightly elevated blackish nodule on the vermilion border and the outer mucosa of the right side of the upper lip [Figure 1]a. Dermatoscopic examination showed arborizing vessels and large blue–gray ovoid nests [Figure 1]b. A biopsy specimen revealed multiple nests of basaloid cells with peripheral palisading in the mid-dermis [Figure 1]c. The nodule was surgically removed at the plastic surgery department of our university hospital. There was no local recurrence or regional lymph node metastasis within a 2-year follow-up period [Figure 1]d. Written informed consent was obtained from the patient.{Figure 1}

 Discussion



BCC occurring on the lip has been rarely reported although the estimated low incidence could be due to the underreported status. It is relatively easy to diagnose BCC by the clinical appearance; however, there are several differential diagnoses including malignant melanoma, pigmented poroma, nevus, and other pigmentary tumors. To the best of our knowledge, there are four large case series and limited number of case reports on BCCs of the lip in the literature [Table 1].[1],[2],[3],[4] In total, 64 cases have been reported including our patient. The male-to-female ratio of these cases was 1.1:1, and the mean age was 66.4 years. Of the 64 cases, 39 (61%) cases and 25 (39%) cases occurred on the upper lip and on the lower lip, respectively. Clinical features included seven nodules, six ulcerative lesions, three erosive lesions, and two papules (others were undetermined). The median size of the lesions was 12.3 mm (3–30 mm). Histopathologically, 25 cases were classified into the following types: nodular (44%), infiltrative (32%), morpheaform (12%), micronodular (4%), superficial spreading (4%), and nonspecific/mixed features (4%). Lymph node metastases were not revealed in any studies. Silapunt et al. showed the evidence of tumor infiltration of the nerve, muscle, or vessels in 6 of their 18 cases.[4] de Sousa et al. described a patient with morpheaform type BCC infiltrating deeply into the orbicularis oris muscle and two cases of nodular type neoplasm infiltrating into the superficial muscular layer.[3] These studies have revealed that BCC on the lip has a tendency to locate on the upper lip.[18]{Table 1}

Regarding the pathogenesis of BCC of the lip, several hypotheses have been suggested. Some authors insisted that tumor cells arise from pluripotent epithelial cells,[19] while others considered that they arise from free sebaceous glands (Fordyce's spots) or traumatic epithelial implantation.[20],[21] The lip epithelium contains four parts: the skin, the vermilion border, the outer mucosa (vermilion), and the inner mucosa.[17] Because of the thin submucosal layer of lips, BCC easily invades deeper structures of the lips. In the surgical treatment of cancer of the upper lip, proper restoration of the lip form and function is of paramount importance as the lips play critical roles in feeding, speaking, and facial expression, among others. Therefore, it should be considered that the goals of lip reconstruction are both functional and esthetic. Full-thickness defect involving over one-third of the lip must be repaired with tissue transfer. Abbe flap is a well-established method using residual lip tissues in two stages and has the advantage of augmenting the upper lip with similar tissues from the lower lip and remaining the balance between upper and lower lips. The flap is designed with half the size of the defect, elevated based on a main artery of the labial artery, and transposed into the defect. The pedicle of the flap can be divided 10–14 days after surgery when the blood supply has been established. Plastic surgeons in our hospital performed the resection of the BCC with 6-mm safe margin and the reconstruction using the Abbe flap. Our patient had a good course after discharge without either local recurrence or metastases during 2 years.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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