Question

The ideal management for squamous cell carcinoma of the middle one-third of the lower lip (1 x 1 cm in size), without lymph node involvement, would be:

• A. Chemoradiotherapy
• B. Local resection followed by radiotherapy
• C. Excision with primary repair
• D. Primary irradiation

Hint:

Think about the size threshold below which surgery alone is enough.

Answer 1

The Correct Option is C

Step 1: Understanding the Question:
The question presents a small (1 x 1 cm), node-negative squamous cell carcinoma of the lower lip and asks for the ideal management, testing how tumor size and stage should guide the choice of treatment.

Step 2: Key Concept or Approach:
Lip cancer staging directly drives treatment choice. Small (under 2 cm), superficial, node-negative lesions are best treated with surgery alone, because cure rates approach 90-95%, the lip can usually be closed primarily (wedge or V-excision) with a good cosmetic and functional result, and this avoids the morbidity of radiotherapy such as mucositis, xerostomia, and skin changes. Radiotherapy is generally reserved for larger lesions, cases where surgery would badly compromise lip competence, patients unfit for surgery, or as an adjuvant when margins or nodes turn out positive.

Step 3: Working Through the Options:
Chemoradiotherapy is overtreatment for a tiny node-negative lesion; it is reserved for advanced or unresectable disease. Local resection followed by radiotherapy adds unnecessary adjuvant radiotherapy after what should be a clean small excision, increasing toxicity without added benefit. Primary irradiation alone is a valid option for lip cancer, but it is generally chosen when surgery would cause unacceptable cosmetic or functional loss for larger lesions, which does not apply to a 1 cm tumor where excision gives an excellent result. Excision with primary repair achieves complete removal with clear margins, cures the disease, and preserves lip function and appearance, making it ideal for this small lesion.

Step 4: Conclusion:
The ideal management is excision with primary repair.