Saywell and Weedon identified histologic risk factors associated with primary squamous cell carcinoma of the lip that metastasized. This can help identify patients who may require more aggressive evaluation, management and monitoring. The authors are from Royal Brisbane Hospital in Queensland, Australia.
Parameters associated with metastatic disease:
(1) histologic grade of the tumor at the surface
(2) histologic grade of the tumor at its deep margin
(3) perineural spread
(4) muscle invasion
(5) stromal sclerosis
(6) tumor thickness in millimeters (from top of the epidermis to the deepest tumor cell; if ulcerated the location of the epidermis was estimated)
|
Histologic Features |
Grade |
|
well-differentiated, little atypia, abundant keratin |
I |
|
moderate atypia, variable keratin |
II |
|
poorly differentiated, severe atypia, no or minimal keratin |
III |
|
anaplastic or spindle cell morphology |
IV |
|
Histologic Parameter |
Finding |
Points |
|
histologic grade at surface |
Grade I |
0 |
|
|
Grade II, III or IV |
1 |
|
histologic grade at deep margin |
Grade I or II |
0 |
|
|
Grade III or IV |
1 |
|
perineural spread |
none |
0 |
|
|
present |
1 |
|
muscle invasion |
none or superficial |
0 |
|
|
extensive |
1 |
|
stromal sclerosis |
none |
0 |
|
|
present |
1 |
|
tumor thickness in mm |
< 2.0 mm |
0 |
|
|
2 - 6 mm |
1 |
|
|
> 6 mm |
2 |
points based on discussion and Table 1, page 194
total number of risk factors associated with metastasis =
= SUM(points for all 6 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 7
• The more risk factors present the greater the risk of metastatic disease.
Specialty: Hematology Oncology, Surgery, general, Otolaryngology
