Nodal Metastasis in Vermillion, Cutaneous, and Mucosal Lip Squamous Cell Carcinoma: Examining Vermillion Invasion
James R. Gardner, Kenny Nguyen, Lindsey Herberger, Isabella Zaniletti, Peter Eckard, Robert Phillips‐Cosio, Carissa Saadi, Mauricio Moreno, Emre Vural, Jumin SundeAbstract
Objective
To compare oncologic outcomes among vermillion, nonvermillion cutaneous, and mucosal lip squamous cell carcinoma (SCCa), with a focus on the prognostic significance of vermillion SCCa.
Study Design
Retrospective cohort study.
Setting
Tertiary academic medical center.
Methods
This retrospective cohort study included all patients diagnosed with SCCa of the mucosal, nonvermillion, or vermillion lip between 2013 and 2024 at our tertiary institution. Subsites were compared in terms of categorical variables using Fisher's exact or χ 2 tests, and continuous variables with Kruskal‐Wallis test. Covariate‐adjusted Cox proportional hazards regression was used to estimate the relative hazard of mortality by subsite.
Results
Two hundred and ninety‐three patients were identified. Subsites included 44.0% vermillion, 38.9% nonvermillion, and 17.1% mucosal lip. Mucosal tumors were more often stage II or higher (58.0%) than nonvermillion (8.7%) or vermillion (22.5%). In pairwise comparisons, nodal metastasis rates were significantly higher for mucosal (24%) and vermillion (14%) than nonvermillion (0) ( P < .001). Nonvermillion and vermillion SCCa showed significant lower hazard than mucosal SCCa (HR 0.32, 95% CI 0.16‐0.66, P = .002, and HR 0.31, 95% CI 0.15‐0.63, P = .001, respectively), though this difference no longer persisted after covariate‐adjustment. Recurrence rates did not differ following treatment ( P = .291). Mucosal SCCa had worse disease‐specific mortality (20.5%) than vermillion (2.6%) or non‐vermillion SCCa (0) ( P < .001).
Conclusion
Vermillion and mucosal lip SCCa show higher nodal involvement than nonvermillion SCCa. Mucosal SCCa demonstrates worse survival in unadjusted analysis, prior to covariate‐adjustment. Larger studies are needed to validate the adjusted association and clarify long‐term prognostic implications.