Lips are commonly involved by non-melanoma skin cancer. Basal cell carcinoma (BCC) involves predominantly the upper lip (skin), whereas squamous cell carcinoma (SSC) the lower lip (vermilion). Lip cancer in the earlier stages has a good prognosis. Advanced stages of BCC with bone infiltration are surgically and oncologically very challenging. SCC of the lower lip with lymph node metastasis has a poor prognosis. Surgical techniques for tumour resection play a critical role on the functional and aesthetic outcome. The vermilionectomy, as a supplementary treatment of lower lip carcinoma in presence of actinic cheilitis, improves the oncological outcome.
An algorithm for lip reconstruction will be presented. The concept is based on the length of the resulted lip defect. The authors choose a rectangular excision and a bilateral step stair technique according to Johanson for lower lip defects up to 2/3 of the lip length. For lower lip defects >2/3 an Abbe flap is supplemented with Johanson plasty. In subtotal lower lip defects a double Abbe flap and a Johanson plasty is the first choice. For an upper lip defect up to 1/3 of the lip a rectangular resection with inclusion of a crescentic peri-alar skin excision is recommended. Upper lip defects >than 1/3 of the lip are repaired with an Abbe flap and a Johanson plasty in the lower lip (donor area). Upper lip defects including more than 2/3 of the lip are reconstructed with the techniques mentioned before and supplemented by nasolabial flaps.