From the Guidelines
Elective nodal radiotherapy is not recommended for this patient. The patient has a pT2N0M0 G1-2 squamous cell carcinoma of the left lower lip with a depth of invasion of 3mm, clear margins for the invasive component, and no lymphovascular or perineural invasion, as reported in the histopathology results 1. The CT scan confirms no evidence of nodal involvement.
Key Considerations
- The risk of occult nodal metastasis in this case is low, given the absence of high-risk features such as perineural invasion, lymphovascular invasion, or deep invasion beyond 5mm.
- The positive margin for intraepidermal carcinoma (IEC) is of less concern for nodal spread as this represents in situ disease without invasive potential 1.
- Management should focus on ensuring complete excision of the IEC component rather than elective nodal treatment.
Recommended Approach
- Close follow-up with clinical examination of the regional lymph nodes would be appropriate to monitor for any subsequent nodal disease.
- Adjuvant radiation therapy may be considered for primary cSCC with concerning perineural invasion or otherwise at high risk for regional or distant metastasis, but this is not the case here 1.
Outcome Prioritization
- The decision to not recommend elective nodal radiotherapy prioritizes minimizing morbidity and preserving quality of life, as the risk of nodal metastasis is low and the potential benefits of radiotherapy do not outweigh the potential risks in this scenario.
From the Research
Patient Overview
- The patient has a pT2N0M0 G1-2 SCC of the left lower lip.
- The patient underwent excision on 21/2/25, with a 16 mm SCC and a depth of invasion (DOI) of 3 mm.
- The margins were clear for invasive cancer, but there was a positive margin for intraepithelial carcinoma.
- There was no lymphovascular invasion (LVI) or perineural invasion (PNI).
- A CT scan of the brain and neck showed no evidence of metastatic disease or nodal involvement.
Elective Nodal Radiotherapy
- The decision to use elective nodal radiotherapy (ENRT) depends on various factors, including the risk of nodal recurrence and the potential benefits and harms of treatment 2, 3.
- ENRT has been shown to reduce the risk of nodal recurrence in certain cancers, such as prostate cancer 2, 3.
- However, ENRT can also increase the risk of toxicity, particularly in the head and neck region 4, 5.
- The patient's cancer type and stage, as well as the presence of adverse features such as LVI or PNI, should be considered when deciding whether to use ENRT 6.
Considerations for This Patient
- The patient has a low-risk cancer with a small DOI and no LVI or PNI.
- The margins were clear for invasive cancer, but there was a positive margin for intraepithelial carcinoma.
- The patient may not require ENRT, given the low risk of nodal recurrence and the potential harms of treatment.
- However, the decision to use ENRT should be individualized and based on a thorough discussion of the potential benefits and harms of treatment 5, 3.