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squamous cell carcinoma is the most common type of lip and oral cavity cancers . in majority of cases
it follows quite common course , and after the surgery it does not produce any harm .
this case presents unusual and unexpected growth of upper lip squamous cell carcinoma with severe cosmetic problems , and possible health threats .
a 46-year - old woman noticed on her upper lip  a spot , the size of a wheat grain  , which grew rapidly and reached the size of 0.6 cm during a two - week period .
recurrent tumor appeared seven days after the operation , with the extreme swelling of the upper lip .
the patient was sent to a tertiary hospital , where fungal or bacterial infection was excluded .
the change on the patient s upper lip reached the size of 5  2 cm , as soft , reddish nodular tumor .
prognosis of this type of tumor , apart from its size and differentiation level , depends on infiltration in tumor - surrounding tissue , perineural and perivascular spread .
squamous cell carcinoma ( scc ) is the most common type of lip and oral cavity cancers .
it comprises nearly 30% of all oral cavity cancers ( 1 ) . according to medical literature ,
lower lip scc is more common in men and upper lip scc is more common in women , aged over 50 , with upper lip and , more commonly , lower lip exterior skin and mucosa as the predominantly affected area ( 2 ) .
exposure to uv - radiation is a major risk factor , apart from smoking , in the etiopathogenesis of scc ( 3 ) .
according to a comprehensive study from israel , scc is a dominant type of lip cancer , mostly among men aged over 53 and exposed to uv - radiation ( 3 ) . in a retrospective
 prospective study , epidemiological data showed that in almost half ( 45% ) of the oral cavity scc cases among the population in montenegro , both lower and upper lip were affected ( 4 ) .
at the end of january in this year , a 46-year - old woman noticed for the first time a change on the skin of her upper lip resembling  a spot , the size of a wheat grain  , which grew rapidly and during the period of two weeks attained a size of 0.6 cm .
the change was red , hard and painful to touch , attached to the skin .
recurrent tumor appeared in surgical incision area only seven days after the operation , as well as the onset of extreme swelling of the upper lip tumorous tissue ( size < 2 cm ) .
after the hospital admission , the fungal or bacterial infection of the lesion was excluded .
soft , reddish nodular tumor with the size of 5  2 cm with sebaceous cysts and telangiectasias was clinically observed ( figures 1 and 2 ) .
swollen lymph nodes ( < 13 mm diameter ) were detected on both sides of the neck and in the right axillary fossa there was one swollen lymph node around 10 mm in size .
well differentiated , keratinized , squamous cell carcinoma of the upper lip was diagnosed after the histopathological audit .
tumorous tissue infiltrated all papillary and reticular dermis , muscle fibers and perineural spaces and is visible on the lower resection line ( figures 3 and 4 ) . with the second surgical intervention
final postoperative result was shown in the figure 5 . in the time of the second surgical intervention , lymph nodes on both sides of the neck
earlier detected lymph node , with almost normal ultrasound characteristics , could not be seen or palpated , thus there was no need for a lymph node biopsy .
further oncological treatment was not advised for the patient , only subsequent medical check - ups of the operated area .
risk factors for scc are : exposure to uva and uvb radiation , treatment with methoxalen and uva radiation , exposure to ionizing radiation , genodermatoses , oculocutaneous albinism , xeroderma pigmentosum , human papillomavirus ( hpv ) infection especially with types 6 , 11 , 16 and 18 , chemical carcinogens ( arsenic , polycyclic aromatic hydrocarbons ) , immunosuppression and use of immunosuppressors , organ transplantation , leukemias and lymphomas , skin diseases with chronically damaged skin , etc .
other risk factors are : ulcerations , osteomyelitis , radiation dermatitis , dystrophic epidermolysis bullosa , smoking , burns , chronic fistulas , etc .
precancerous changes in the skin and the mucosas such as : actinic keratoses , arsenic keratoses , keratoses caused by exposure to ionizing radiation , bowen s disease and erythroplasia of queyrat , are all obvious risk factors for scc ( 5 ) .
we could not find any correlation between the above mentioned risk factors and our patient .
she is a nonsmoker and she has not suffered from repeated herpes infections or other diseases . according to the literature , localization of cancer on the upper lip is more common in women than in men , as it is presented in our case , while the lower lip cancer , especially scc , is more common among men , ranging from 6 - 10 to 1 ( 3 , 7 ) .
high incidence rates have been found in men in north america , europe and oceania , while the frequency of scc is rare in asia ( 8) .
epidemiological studies performed over the past 40 years have detected several regions with a decline of the lower lip cancer incidence rates among men as well as a stable and slightly increasing lip cancer incidence rate among women , which is associated with a reduced ratio of men from 6:10 to 2 - 3 : 1 .
the number of upper lip cancer cases globally increased up to 40% of all oral cancers .
however , over 90% of all lower lip cancer cases are scc cases ( 9 ) .
although in this case the histopathological findings indicated the possibility of perineural spread of tumor , complete surgical removal of the cancerous tumor and the margin of healthy tissue , is followed by the absence of metastatic changes for the time being .
this case confirms the assumption that the histologic and nuclear grades of tumor are not prognostic factors for recurrences and regional metastases of lip scc ( 10 ) .
it is a factor that allows the distribution of oral cancer patients in groups with a higher or lower risk of recurrence and/or metastatic disease .
according to the literature , the risk for regional metastases increases 2.8 times with increasing of lip scc size over 2 cm in diameter ( 4 ) .
the authors present the case of a patient with squamous cell carcinoma of the upper lip pointing out the importance of early detection and complete surgical removal of such tumors concerning the fact that this case suggests a higher prognostic significance of the size of the upper lip cancer , as well as the infiltration in tumor - surrounding tissue , mainly the perineural and perivascular spread , than the degree of its histological differentiation for the development of metastatic changes in cancer patients .
introduction : squamous cell carcinoma is the most common type of lip and oral cavity cancers . in majority of cases it follows quite common course , and after the surgery it does not produce any harm . 
 this case presents unusual and unexpected growth of upper lip squamous cell carcinoma with severe cosmetic problems , and possible health threats.case presentation : a 46-year - old woman noticed on her upper lip  
 a spot , the size of a wheat grain  , which grew rapidly and reached the size of 0.6 cm during a two - week period . 
 the lesion was red , hard and painful , attached to the skin . 
 it was surgically removed , and primary histopathological finding was follicular keratosis . 
 recurrent tumor appeared seven days after the operation , with the extreme swelling of the upper lip . 
 the patient was sent to a tertiary hospital , where fungal or bacterial infection was excluded . 
 the change on the patient s upper lip reached the size of 5  2 cm , as soft , reddish nodular tumor . 
 squamous cell carcinoma was diagnosed after the histopathological audit . with the second surgical intervention 
 the tumor was removed and the defect reconstructed.conclusions:prognosis of this type of tumor , apart from its size and differentiation level , depends on infiltration in tumor - surrounding tissue , perineural and perivascular spread . 
 therefore , it is always necessary to analyze the removed skin especially on margins .