Is neck dissection necessary in early stage lower lip carcinomas necessary?

Abstract

Lower lip tumours are the most common of all oral cavity tumours. The purpose of this article was to analyse neck metastasis rates of early stage lower lip carcinomas and to evaluate possible correlations of histological parameters with neck metastasis. A retrospective review was made of 37 patients in respect of the dissection type, preoperative detection of lymphadenopathy by palpation or computed tomography (CT), tumour size and degree of histological differentiation. An experienced pathologist also re-evaluated the specimens and examined tumour depth and muscle invasion. Types of neck dissection were bilateral supraomohyoid in 20, unilateral supraomohyoid in 8, bilateral suprahyoid in 5 and unilateral suprahyoid in 1 patient. All the carcinomas were squamous cell carcinoma (SCC) and T stages were T1 in 32 and T2 in 5. Preoperatively, 4 patients had palpable lymph nodes and 9 patients had lymph nodes on CT scan, but none of these patients had histologically positive lymph node metastasis. Histological node metastasis was found in only 1 patient who had stage T1 tumour, no palpable or detected lymph node, no muscular invasion and very limited tumour depth. Tumour size, differentiation degree, tumour depth and muscle invasion do not seem to be sensitive indicators for the prediction of lymph node metastasis in early stage lower lip carcinomas. The necessity of neck dissection in early stage lower lip carcinomas should be reconsidered in a large series of patients.