Introduction

Lip carcinoma, or so-called lip cancer, can be easily detected in earlier stages compared with other head and neck tumours. Treating lip cancer in its early stage can slow the degenerative process and prevent cancer from spreading to other organs. Patients' awareness and clinicians' acumen are crucial for early diagnosis of oral cancer. Lips are one of the body parts that are easily exposed to the outside environment; in other words, they are more vulnerable and susceptible to damage.

If you're noticing unusual changes on your lips, such as a spot that is constantly growing and feels sore, it could be an early sign of cancer. The earlier we act to address the lesions, the more effectively we can combat the disease. Many people are unsure whether to worry or wait when it comes to lip changes. That uncertainty can be dangerous. This article aims to help you understand the early signs and symptoms of lip cancer, recognise potential risks, and know when to seek medical attention.

Understanding and recognising the early signs of lip cancer

Lip cancer is one of the most common oral cavity cancers, especially localised in the lower lip (90–95%). Due to the visible location, it is typically detected in the early stage, with research reporting that 75–80% of cases are diagnosed at stage T1. The factors, such as UV exposure, smoking, radiotherapy, and genetics, could cause and increase the possibility of lip cancer development. In addition, it is the most common malignant tumour in the head and neck region and performs similarly to skin cancer. The majority of cases are identified as squamous cell carcinomas, followed by Basal cell carcinoma. While mucosal lip cancers usually affect the lower lip, non-mucosal forms from minor salivary glands more often involve the upper lip.^1,2

Moreover, lip cancer primarily impacts older males. The average age of patients was reported to be 65, and over 96% of cases were men. Although it is less common in younger individuals, a small number of patients were under 40, or even around 21 years old. In terms of habits, tobacco use was a major contributing factor compared to alcohol. A large portion of patients were heavy smokers.³

Over 95% of oral squamous cell carcinomas (SCCs) present as ulcers or masses, with early lesions appearing as subtle, flat, discoloured areas like leukoplakia or erythroplakia. In some cases, it may be painless. A non-healing ulcer is the most common sign. Advanced tumours may invade nearby structures, causing symptoms like tooth mobility, trismus, sensory changes, referred ear pain, and neck masses.²

Key Early Symptoms to Monitor:

• Persistent sores or ulcers that do not heal within 2–3 weeks
• Presence of red or white lesions (leukoplakia/erythroplakia)
• Unexplained bleeding or numbness around the lip region
• Lumps or thickening of the lip tissue
• Changes in lip texture

Lip cancer usually appears as a raised, crusty spot on the lip. In some cases, it is associated with signs of sun damage or colour change, mucosal thinning, and leukoplakia. Early-stage lip cancers (AJCC Stage I and II) are highly curable with surgery or radiation. Treatment choice depends on cosmetic and functional outcomes, as well as the treating specialist’s expertise.

• 1: Stage I: Tumour size is the same or smaller than 2 cm, without lymph node involvement
• 2: Stage II: Tumour size is larger than 2 cm but smaller than/or the same size as 4 cm, no lymph node involvement

The larger size of cancers, especially those over 3 cm, and the signs of metastasis were more difficult to treat, leading to lower survival rates. In contrast, patients with cancer with clear surgical margins and smaller tumours had a higher survival rate.

Treatment of the early signs of lip cancer

General guidelines

For most lip cancer cases, the primary choice of treatment is surgery. By performing the surgery, most of the early-stage lesions are cured successfully. However, for those severe cases, such as T4 or metastases-related, they usually require a combination of surgery along with radiation or chemotherapy. In addition, radiation therapy (RT), particularly, is another alternative for early-stage tumours, especially in patients unfit for surgery or for whom surgical resection is impractical. However, the downsides of RT include prolonged treatment and a risk of jawbone damage. A multidisciplinary team approach is recommended for planning treatment and follow-up, and clinical trial participation is encouraged when possible.

Early-stage lip cancer (T1/T2, N0)

Primary Tumour: Surgical resection with clear margins and reconstruction is preferred. A 3-mm margin with frozen section analysis is generally adequate for T1 lesions; up to 1 cm is recommended for more severe cases. 

Neck Management: Elective neck dissection isn’t usually needed. Sentinel lymph node biopsy may be performed, with completion neck dissection if the node is positive.

Adjuvant therapy

Postoperative radiation is used when surgical margins are positive and re-resection isn't possible, or when adverse features like perineural or lymphovascular invasion are present.

Advanced lip cancer (T3/T4 or any T with N1–N3) is also primarily managed with surgical resection. In some cases, complicated resections are involved, especially when the regions include the mandible or maxilla. The treatment might combine with radiation therapy or chemotherapy, especially when surgery is not feasible.⁴

Diagnosis and assessment of lip cancer

Biopsy and diagnosis

The standard diagnostic procedure involves a surgical biopsy, followed by histological analysis. 

Clinical examination

Clinical examination plays a crucial role in both diagnosing new lip tumours and monitoring patients after treatment. A systematic approach is important. The examination should begin with a detailed history to uncover any co-morbidities or social factors (e.g., smoking or alcohol use) that might affect treatment choices.

Imaging

Imaging is typically not required for early-stage lip cancers, as they are often visible and easily assessed clinically. However, for those that may involve the mandible, computed tomography (CT) or magnetic resonance imaging (MRI) is essential for complete staging and treatment planning. These imaging methods help assess the tumour's relationship to adjacent bone and soft tissue, ensuring appropriate surgical margins. In cases of oral cavity tumours, cross-sectional imaging is nearly always used, 

Pre-treatment staging

The staging of lip cancer follows the TNM (Tumour, Node, Metastasis) system. Staging the disease helps clinicians design a treatment plan and determine the extent of the disease.⁵

When should you see a doctor?

If you have any doubts, it is better to consult with your local healthcare professional. It is crucial to remember not to wait until you experience pain or any other visible symptoms. Early assessments and screening are critical safeguards; a short delay could lead to the progression of the disease.

Prevention

The likelihood of oral cancer is increased by the consumption of alcohol and tobacco. Preventing oral cancer centres on changing lifestyle behaviours. In addition, avoiding excessive exposure to UV light and radiation is another key to preventing lip cancer. For individuals at higher risk, early detection plays a crucial role in prevention. Routine screening and timely detection of oral lesions are crucial for identifying cancer at an early stage. 

Summary

In short, although lip cancer is easy to detect, it can be overlooked. By understanding the early signs of lip cancers, such as texture and colour changes of lips, and consistently unhealed lesions, we would have a better chance of noticing the disease early and seeking out clinicians for diagnosis and assessment. Adjusting our routines, such as applying sunscreen, avoiding tobacco and alcoholic beverages, and implementing good oral hygiene, could reduce the onset of lip cancer and prevent its recurrence. 

When it comes to treating lip cancer, surgery is often the first choice. The tumour is typically surgically removed in order to remove the tissue that is malignant. Early-stage lip cancers can often be successfully cured with a simple resection with clear margins. Reconstructive surgery might be essential to rejuvenate both the function and aesthetic appeal of the lip, ultimately enhancing the patient's quality of life. Treatments for more severe cases are more challenging and complicated.

Prevention and early action are the two best defences. It is important to bear in mind that you should never hesitate or be shy to seek a professional opinion if something seems unusual. Whether it’s a minor irritation or a suspicious lesion, paying attention and acting early can save your health.

Key Takeaway: Early detection saves lives. Act promptly at the first sign of abnormality.