Carcinoma of the lip in Auckland, New Zealand, 1969-1987.
We have retrospectively reviewed the case notes of 180 patients with carcinoma of the lip seen in Auckland between 1969 and 1987. The greater Auckland region is a geographically unique area as it comprises a modest European population (800,000 people) coupled with the largest Maori and Pacific Islander populations in the world (each of approximately 70,000 people). There were 158 patients with T1 lesions, 20 with T2 lesions, and 1 with T3 disease. Only one patient had nodal metastases at presentation. Management was primarily surgical in 138 patients, primarily radiotherapy in 25, and 14 patients received adjuvant radiotherapy after surgical excision. Primary surgical excision was associated with a 20% treatment failure rate (local recurrence and/or development of nodal metastases). Radiotherapy alone as primary therapy was followed by an 80% recurrence rate. When adjuvant radiotherapy was used after excision the failure rate was 21%. In those patients treated with local excision, the major factor predisposing to disease recurrence was the presence of a positive margin, and recurrence in cervical lymph nodes markedly worsened the prognosis. Overall, 83% of patients were alive and well at the time of the review, 7% were either dead of disease or alive with recurrent disease, and 10% were dead of other causes. We conclude from our data that good results can be achieved after surgery for lip cancer, providing negative margins are obtained, and that positive margins require early re-excision. Regional nodal disease infrequently follows complete excision of the primary lesion, but when it occurs it has an ominous significance.