Case of the Month December 2022

An 80 year-old male patient presented to our clinic complaining of a sore lesion on his left lower lip (Figure 1).

A biopsy of the lesion revealed an invasive moderately differentiated squamous cell carcinoma. After discussing treatment options including Mohs surgery, radiation therapy, and referral to plastic surgery, the patient and his wife felt that Mohs surgery would be the best option due to its high cure rate. The patient was also concerned about the cosmetic result, and repair options for the possible resulting defect were discussed.

The surgery and microscopic evaluation of the tissue revealed a very. After three stages of surgery the final defect involved a significant portion of the lower lip (Figures 2). 

The patient stressed the importance of the cosmetic outcome of his lip and after seeing the defect he was doubtful that his lip would ever look normal again. To solve this problem, we decided upon a combination of two closures. Combining a mucosal advancement flap and a small rotation flap we were able to restore the cosmetic appearance of the lip and maintain proper function to ensure that he did not drool every time he sipped a beverage (Figures 3 and 4).

At one week, the sutures were removed, and the early cosmetic result was very pleasing (Figure 5). 

At three weeks, the wound was fully healed (Figure 6).

At one year, there is no evidence of recurrence, and the site has healed with an excellent cosmetic and functional result (Figure 7).