NOTE: Processing cancer can be difficult; it is important to recognise that feelings of confusion and fear are normal. If you are processing a recent diagnosis, troubling symptoms or just want more information, we are here to help. With support, we hope to put you on the right path forward and process any questions you may have. Remember, you are not alone. 

Introduction

The lips exhibit a unique form of oral cancer.¹ Over 79% of patients have favourable long-term results, making it one of the most treatable forms of cancer.² The good news is that with relatively easy detection and a slow spreading nature, treatment is extremely responsive.³ Throughout this article, we aim to tackle the causes, how to reduce the risk and empower patients to make informed decisions. 

The lips are a unique case of cancer

Unlike other forms of cancer, the lips represent a transitional zone. This means that cancer happens on the boundary between the skin and the inner lining of the mouth (mucous membrane) and therefore carries characteristics of both epithelial types.⁴ It is important to recognise that both the cause and development are based on limited evidence; not all aspects of the disease are understood yet.¹ 

For the majority of cases, cancer begins in squamous cells (flat, thin cells on the surface of the lip).⁵ These contain instructions that tell the cells how they should behave and keep the body functioning. Cancer occurs when these instructions are read wrong, creating abnormal cells, and as these continue to grow, they clump together to form tumours. On the lips, these commonly develop into persistent, hard ulcers, but variations in appearance are also seen.⁵

When we think of cancer, we usually associate it with happening deep inside the body. The unique features of the lips, including their thin outer layer (epithelium) and lack of melanin (which causes skin pigmentation and acts as a form of protection), mean they come into direct and constant exposure to cancer-causing factors, some of which we explore next.⁵

How different risk factors lead to cancer

As mentioned, lip cancer can be caused due to direct damage from a number of factors and substances.  Repeated injury caused by these increases the chance of incorrect cell repair and uncontrolled cancer growth. 

The main risks include: 

1. UV Rays 
2. Lifestyle choices

UV rays

Just like the skin, UV rays can harm the lips. However, without melanin, the lips aren’t able to absorb the harmful rays, unlike the skin.²  The risk is further increased as many people forget that their lips need protection with sunscreen too, especially with regular exposure. The lower lip gets more sun, making it the most common site for cancer.²  Similar risks are also posed by tanning beds, which use artificial UV rays.⁷ 

Lifestyle choices 

Including smoking and drinking, these present their own risks for cancer, but together they increase cancer risk by 30 times. Tobacco smoke delivers over 70 known cancer-causing chemicals directly to the lips.⁸ Alcohol dries out the skin of the lips, making them more prone to damage, and as a solvent, it makes it easier for harmful and cancer-causing chemicals to penetrate the lips' thin surface.⁹

Signs and symptoms

Most cases of this cancer are relatively rare and tend to develop later in life (50-60s). However, symptoms usually begin with small changes that are easily overlooked.¹⁰ With early stages looking similar to cold sores, recognising the difference can help you distinguish what and when you should seek help for. Early detection offers the best chance for successful treatment

Watch for the following:⁷

• Persistent sore/ulcer that does not heal within a few weeks. Unlike cold sores, which usually disappear within 7-10 days
• Flat or raised patches on the lips, on lighter skin, may appear pale or red, whereas on darker skin, they may appear brown or grey
•  A combination of either pain, numbness and tingling of the lips or the surrounding area
• Lip cancer can also be associated with more indirect changes to the mouth or jaw, including swelling, bleeding, or thickened gums

Early detection and outlook

If you believe any of these symptoms match what you are experiencing, getting help may be the next step. Below is an outline of the common route in treatment and what to expect. 

Step 1: Booking in with your GP

The goal is to get clarity and a better understanding of your symptoms. At the appointment, the GP may:

•  Ask about your symptoms, how long they have persisted and whether you have noticed any changes
•  Examine your lips
• Ask about family history and determine whether any of your lifestyle choices could influence risk

If your GP notices something that doesn’t seem right, they will refer you to a specialist. This is routine and down to caution, not cause.

Step 2: Specialist assessment and diagnostics 

Here, a more detailed assessment will take place, which may include: 

• A full and thorough examination of lips, mouth, and surrounding area
• Discussions of medical history and lifestyle choice
• The possibility of a biopsy, where a small sample of affected tissue is removed under anaesthetic, is painless and sent to a local laboratory for analysis 

Step 3: Treatment and recovery

If you are diagnosed with lip cancer, it is normal to feel overwhelmed. However, when caught early, treatment is often simple and highly successful.

Treatment can involve the following:^{7, 11}

• Surgical removal: This is the most common and effective treatment for early-stage cancer. The goal is to remove the cancerous tissue whilst preserving as much of the healthy lip as possible. In most cases, the surgery leaves minimal scarring and preserves normal eating and speech patterns. For larger lip cancers, more extensive surgery may be required  
• Radiotherapy: If surgery isn’t suitable or if there’s a higher risk of recurrence, radiotherapy may be recommended. This is usually delivered in 15 treatments over 3 weeks

Patients with early-stage cancer typically recover within a few weeks. However, if radiotherapy is required, this may take several more months to get back to normal.

Prevention and protection

Whilst lip cancer is treatable, prevention is always a better route than a cure. 

Below are some simple lifestyle changes that can reduce the risk and also keep you healthy:⁷

• Use a broad-spectrum lip balm or sunscreen with SPF 30 or higher every day
• Remember to reapply as directed, especially if swimming, sweating or outdoors for long periods of time
• Wear a hat when in direct sunlight to shade your face and therefore your lips
• Stop using tobacco products
• Avoid tanning beds 

Myths and misconceptions 

It’s just a cold sore!

While cold sores are common, a sore on the lip that doesn’t heal could mean something more serious. Unlike cold sores, lip cancer lesions tend to be persistent and painless. 

If it doesn’t hurt, it’s not serious!

Early cancer can be painless, often starting as small changes like a dry patch, discolouration that goes easily unnoticed. 

I don’t need sunscreen!

Lips have less natural protection, meaning they can burn and suffer more UV damage than the rest of your skin. 

Conclusion

Lip cancer is both easily detectable and treatable when caught early enough. Due to both the unique positioning and characteristics of the lips, patients should be advised to take caution and reduce exposure to substances such as tobacco, alcohol and UV light. 

Whilst simple lifestyle changes are the best way forward, patients should find comfort in knowing the cancer is both slow-growing and responsive to treatment. It’s important to monitor symptoms closely and seek medical advice if needed. Staying informed and educated helps to protect your health and reduce your risk.