CASE DISCUSSION

. .

65 . CC: 3 .

65 . CC: 3 .

PI: 4 3 .

65 . PH: No underlying disease No drug allergy SH: 40+ No smoking/alcohol

PHYSICAL EXAMINATIONAn elderly woman, well cooperative Vital signs: BT 37 c, RR 16 /min, PR 70/min, BP 140/80 HEENT: Pink conjunctivae, anicteric sclerae Lower lip mass, irregular surface size 2.5x2.5 cm, firm consistency involed midline of lower lip lateralized to Left side Not involved commissure Inferior border within Vermilion area Mass involved oral mucosa of lower lip not involved buccogingival sulcus or gingivae

Lower lip mass, irregular surface size 2.5x2.5 cm, firm consistency involved midline of lower lip lateralized to Left Side Not involved Lt. commissure Inferior border within Vermilion area

Mass involved oral mucosa of lower lip not involved buccogingival sulcus or gingivae

PHYSICAL EXAMINATIONAR: normal, PR: normal OC : No base of tongue mass, no bulging of Parapharynx, tonsil gr.II both IDL: normal TVC movement, normal pyriform Otoscopy: normal EAC & TM both ear Neck : Cervical Lymph node impalpable Heart and Lung: Normal Abdomen: soft, not tender Extrimities: no other skin lision, no Axillary LN/ Inguinal LN

PROBLEM LISTS

DISSCUSSIONS

PATHOLOGYWell differentiated, SCCA Neoplasm extending to line of excisional margin

DISSCUSSIONS

LABCBC : Hct 44.8% ,WBC 5900 uL , Plt 230000 uL, Ne47.4%, Ly39.5%, Mo7.3, Eo5.0% , Ba0.8% ,MCV84.6 CXR: No active chest disease EKG: Normal Sinus Rhythm

DISSCUSSIONS

LIP CA Lower lip (88-95%)>>Upper(2-7%)>Commissure 1% Lower SCCA> Basal cell CA Differential Dx: keratoacanthoma, minor salivary gland tumors, malignant melanoma, mesenchymal(malignant fibrous histiocytoma, leiomyosarcoma, fibrosarcoma, angiofibroma and rhabdomyosarcoma) Ulcerated lesion on the vermillion or cutaneous surface, less common on the mucosal surface

LIP CA-METASTASIS Neck metas: infrequent of lower lip (10%) Can metas bilateral Increase risk: commissure + upper lip Bad prognostic factor perineural invasion, bony involved, arise in commissure or upper lip, regional LN metas,