Forty-one patients were treated with Mohs micrographic surgery for welldifferentiated superficial squamous cell carcinoma of the lip; 34 had closure of their surgical site by a mucosal advancement flap, and five were allowed to heal by second intention. Cases were limited to TlNOMO or TBNOMO, these being early superficial lesions. Primary closure by mucosal advancement provides cosmetic and functional healing for these lesions. The combination of Mohs micrographic excision and mucosal advancement closure may be considered standard office or outpatient surgical management of these common tumors. Cancer 66:463-468,1990.
HE INCIDENCE of cutaneous malignancy has in-
T creased, as has public awareness of this problem. As a result, physicians now more than ever concentrate their efforts on the early diagnosis and treatment of skin cancer, including squamous cell carcinoma of the lip. In patients with fair skin, solar damage, and a history of cutaneous malignant and premalignant disease, squamous cell carcinoma should be highly suspected. Because squamous cell carcinoma of the lip may be life-threatening, early diagnosis and treatment are of particular importance. Many of the stages of this tumor, as categorized by the American Joint Committee for Cancer Staging,' are managed by extensive surgical procedures. However, early lesions (Stage T 1 -2NOMO) are managed easily in an office or outpatient setting by Mohs micrographic surgery, followed by a mucosal advancement flap or other closure. 2-s
We studied 41 consecutive patients treated by one of the authors (R.K.R.) who had follow-up of 13 to 42 months (average, 25 months). Thin, well-differentiated squamous cell carcinomas of the lip, measuring less than 4.0 cm in maximal diameter (after excision), were removed by the Mohs micrographic fresh-frozen technique. Most of the lesions were on the lower lip and closed with a mucosal advancement flap.
Mohs micrographic surgery is an office or outpatient procedure in which the most accurate histologic tumor-From the Department of Dermatology, Mayo Clinic and Mayo Foun-Address for reprints: Randall K. Roenigk, MD, Department of Der-