Lip Cancer: Symptoms, Stages and Treatment

A sore on the lip that hasn't healed for weeks, a patch that crusts over, flakes off and crusts again, or a small painless lump is easy to brush aside. Many people put these changes down to a cold sore, a mouth ulcer or sunburn, yet they are sometimes the first signs of lip cancer. The good news is that because lip cancer develops where you can see it, it is usually noticed early, and most patients treated at an early stage make a full recovery.

What is lip cancer?

Lip cancer is a malignant tumour that starts in the skin of the lip or in its red part (the vermilion). It is one of the most common oral cancers, and most cases occur in people over 50 who have spent many years in the sun. Around 90% of cases affect the lower lip, because it takes the full force of direct sunlight.

The vast majority of lip cancers are squamous cell carcinomas. This type mainly affects the lower lip and, if left untreated, can spread to the lymph nodes in the neck. On the upper lip, basal cell carcinoma is more common. Basal cell carcinoma grows slowly and rarely spreads to distant parts of the body. Melanoma and tumours arising from the salivary glands are very rare on the lip.

Lip cancer symptoms: what are the first signs?

Lip cancer usually starts quietly. There is no pain at first, and the change can look like chapped lips or a cold sore that won't clear up. The most common symptoms are:

• A sore or crack that hasn't healed within two to three weeks

• A patch that crusts over, bleeds when the crust comes off and then crusts again

• A rough white or red patch on the red part of the lip

• A firm area, thickening or small lump you can feel

• A blurred border between the red of the lip and the surrounding skin

• In later stages, numbness or pain in the lip, or a swelling you can feel under the jaw

Lower lip cancer symptoms

On the lower lip, cancer usually begins in the middle or at the side as a dry, cracked area that keeps peeling. Over time a sore with slightly raised edges forms on this area and gradually hardens. In people who always hold a pipe or cigarette in the same spot, the tumour often appears exactly there. Lower lip cancer is frequently preceded by actinic cheilitis, a chronic form of sun damage to the lip. If your lip is constantly dry, peeling or turning whitish, have it checked by a dermatologist.

Upper lip cancer symptoms

Cancers of the upper lip usually develop in the skin above the lip, close to the nose. They typically look like a small, shiny, pearly bump that sinks in the middle over time and bleeds easily. Because they grow slowly, they can be mistaken for a spot or a mole for years. Tumours in this area behave like skin cancer; for more detail, see our page on skin cancer.

Cold sore, canker sore or lip cancer?

Most sores on the lip are harmless. The table below can help you tell them apart, but only an examination, with a biopsy if needed, can give a definite diagnosis.

In short, any sore on the lip that lasts longer than three weeks and doesn't improve with creams should be examined by a doctor.

What causes lip cancer?

The main cause is sunlight. Ultraviolet damage builds up over the years and harms the DNA of the cells in the lip. That is why lip cancer is more common in people who work outdoors, such as farmers, fishermen and construction workers. Other risk factors include:

• Smoking cigarettes or cigars, and pipe smoking in particular

• Chewing tobacco and heavy drinking (the risk rises sharply when combined with tobacco)

• Fair skin that burns easily

• Being male and over 50

• Taking immunosuppressive medication, after an organ transplant or for other reasons

• A previous skin cancer

• Long-standing actinic cheilitis

Quitting smoking is one of the most effective ways to lower your risk of lip and mouth cancer. Our Stop Smoking Clinic can support you.

How is lip cancer diagnosed?

The doctor carefully examines the lip, the inside of the mouth and the lymph nodes in the neck. A small piece of tissue is taken from the suspicious area under local anaesthetic for a biopsy, and the diagnosis is confirmed by pathology. If cancer is found, a neck ultrasound, CT or MRI scan may be ordered to see how deep the tumour goes and whether it has reached the lymph nodes. PET-CT may also be used for larger tumours.

Lip cancer stages

Staging is based on the size of the tumour, whether it has grown into nearby tissue and whether it has spread to the lymph nodes.

Stage 1 lip cancer responds best to treatment. At this stage the tumour is confined to the lip and can often be removed completely in a single operation. Further treatment may not be needed.

Is lip cancer deadly? Survival rate

Lip cancer has one of the best outlooks of all head and neck cancers. In patients treated before it spreads to the lymph nodes, the five-year survival rate is over 90%. That outlook, however, depends on catching the disease early. Tumours left untreated for years can spread to the lymph nodes in the neck, and treatment then becomes more extensive and less likely to succeed. Waiting because "it doesn't hurt anyway" is the biggest risk.

Lip cancer treatment

Treatment is planned jointly by head and neck surgeons, plastic surgeons and radiation oncologists, based on the type, size and location of the tumour and the patient's general health.

Surgery

Surgery is the main treatment for lip cancer. The tumour is removed together with a margin of a few millimetres of healthy tissue. If the tumour takes up less than a third of the lip, a V-shaped or wedge excision is performed and the edges are stitched directly together; with this technique the lip keeps most of its function and appearance. For larger tumours, the lip is reconstructed using tissue from the cheek or the opposite lip. This reconstruction is the specialty of our plastic and reconstructive surgery team. Some basal cell carcinomas can be treated with Mohs surgery, in which the tumour is removed layer by layer and each layer is examined under the microscope straight away.

If the cancer has reached the lymph nodes, or the tumour is large and deep, the lymph nodes in the neck are removed during the same operation (neck dissection).

How long does lip cancer surgery take?

It depends on the size of the tumour and the reconstruction required. A wedge excision of a small, early-stage tumour usually takes 30–60 minutes under local or general anaesthetic, and the patient can often go home the same day or the next. Operations that involve rebuilding the lip with tissue grafts and a neck dissection can take 3–5 hours and may require a hospital stay of a few days.

Radiotherapy and drug treatment

For patients who are not suitable for surgery, or when surgery would seriously affect how the lip works, radiotherapy may be used as the main treatment. Additional radiotherapy is given after surgery if tumour cells may remain at the surgical margins or if spread to the lymph nodes has been found. In advanced disease, chemotherapy, targeted therapy or immunotherapy may be added. These treatments are planned by our radiation oncology and oncology departments.

Does lip cancer go away on its own?

No, lip cancer does not go away by itself. Ointments, herbal remedies, or drying out or burning the sore may close the surface for a while, but they do not destroy the tumour underneath. In fact, they delay diagnosis and give the tumour time to grow. The only real cure for lip cancer is surgery or radiotherapy once it has been diagnosed. At an early stage, this treatment usually works in one go and for good.

Recovery after lip cancer surgery

Swelling, tightness and mild pain in the lip are normal in the first few days after surgery. The pain can usually be managed with simple painkillers. Swelling goes down noticeably within one to two weeks, and the stitches are removed after about a week.

• In the first few days, choose soft, lukewarm or cold foods that are easy to chew. Drinking through a straw can help avoid straining the lip.

• Keep your mouth clean and rinse gently after meals.

• Do not smoke until the wound has healed; smoking slows healing and increases the risk of the cancer coming back.

• Protect your lip from the sun and use a lip balm with SPF until the scar has fully matured, which takes about a year.

After a major reconstruction, the lip may feel numb for a while or the mouth may not open as wide. These problems usually improve over a few months.

Regular follow-up after treatment is essential. Check-ups are more frequent in the first two years and less frequent after that. At each visit, both the lip and the lymph nodes in the neck are examined. People who have had lip cancer are also more likely to develop a new cancer elsewhere in the mouth or on the skin, so skin checks should not be skipped.

Can lip cancer be prevented?

Most lip cancers can be prevented. The simplest steps are avoiding long periods outdoors between 11 a.m. and 4 p.m., when the sun is strongest, wearing a wide-brimmed hat and reapplying a lip balm with SPF often during the day. Staying away from cigarettes and other tobacco products, limiting alcohol and having any lip change that doesn't heal checked early also lower the risk considerably.

Lip cancer is treated by the same specialists who manage other cancers of the mouth and the head and neck region. To learn more, see our pages on mouth cancer and head and neck cancers.

Lip cancer: frequently asked questions