INTRODUCTION
Cancers of the lip are the second most frequently encountered skin cancer in the head and neck region, accounting for approximately 0.6% of all malignancies overall in the United States. The majority of these skin cancers are diagnosed in male patients, with some studies reporting a male-to-female ratio of 5-8:1, potentially owing to trends in sun exposure with various occupations and trends in alcohol and tobacco use. In addition to the known carcinogenic effect of ultraviolet radiation, other potential pathologic factors contributing to the incidence of lip cancer include pathogens such as human papillomavirus and Epstein-Barr virus, arsenic exposure or occupational exposures, and immunosuppression. Squamous cell carcinoma (SCC) is the most frequently diagnosed cancer of the lip, making up greater than 90% of cancers in this location, and generally occurs at a greater frequency on the lower lip compared to the upper lip.1 Skin cancers involving the lip additionally confer a greater risk of recurrence, deep invasion, and metastasis than skin cancers on other sun-exposed surfaces.2
Owing to the sensitive location and necessity to preserve as much normal tissue as possible while achieving negative surgical margins, skin cancers on the lip are encountered with some frequency in the Mohs surgery clinic, with the surgical defects created from these operations presenting a significant reconstructive challenge. Reconstructive surgeons must account chiefly for the critical functional role of the lips in vocal articulation, nonverbal communication, and full closure of the mouth when eating and drinking to avoid loss of oral contents. As the dominant cosmetic feature of the lower face, the importance of the aesthetic outcome of any reconstruction undertaken on the lips cannot be overstated. Several studies published on results of second intention healing (SIH) on the lips have reported good cosmetic and functional outcomes in wounds mainly confined to the vermilion lip and into the superficial portion of the orbicularis muscle.3,4 Others have cautioned against utilizing SIH on wounds extending beyond the vermilion to the cutaneous lip, or those that extend into the orbicularis oris muscle given the risk of formation of a depressed scar or distortion of the vermilion border.5,6
Owing to the sensitive location and necessity to preserve as much normal tissue as possible while achieving negative surgical margins, skin cancers on the lip are encountered with some frequency in the Mohs surgery clinic, with the surgical defects created from these operations presenting a significant reconstructive challenge. Reconstructive surgeons must account chiefly for the critical functional role of the lips in vocal articulation, nonverbal communication, and full closure of the mouth when eating and drinking to avoid loss of oral contents. As the dominant cosmetic feature of the lower face, the importance of the aesthetic outcome of any reconstruction undertaken on the lips cannot be overstated. Several studies published on results of second intention healing (SIH) on the lips have reported good cosmetic and functional outcomes in wounds mainly confined to the vermilion lip and into the superficial portion of the orbicularis muscle.3,4 Others have cautioned against utilizing SIH on wounds extending beyond the vermilion to the cutaneous lip, or those that extend into the orbicularis oris muscle given the risk of formation of a depressed scar or distortion of the vermilion border.5,6
