ANSWER
The correct answer is all of the above (choice “g”).
DISCUSSION
Squamous cell carcinoma (SCC) of the lip—almost always the lower lip—is quite common and appears to be caused by several factors. These can include exposure to ultraviolet light, ionizing radiation, arsenic (through contaminated groundwater or certain medications), tobacco, and human papillomavirus.
Early on in its manifestation, this patient’s SCC could have been excised with margins, producing an excellent prognosis. But with the extended delay in diagnosis and apparent related adenopathy, the patient’s future looked much less certain. At the very least, he would face extensive surgery, possible lymph node dissection, and maybe chemo and radiation therapies. Metastasis to the brain and lung(s) were very real possibilities.
The history associated with this case is far from uncommon, since these cancers are often mistaken for infection, which further delays correct diagnosis and treatment. Compounding this problem—and for reasons unclear to this author—affected patients are often referred to the wrong specialist. The critical missing piece of information was a diagnosis, which could only have been obtained through an incisional biopsy. Only then could the patient be referred appropriately.
Fortunately, in this case, the patient ended up under the care of a head and neck surgeon who planned to address this tumor after imaging of the head, neck, and lungs was completed.