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Have high blood pressure, dark, dry and peeling lips. Should I be worried for cancer?

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Practicing since : 2006
Answered : 2015 Questions
hi can i attach a photo for you to tell me what u think this is?
can you tell me if this is lip cancer and what type of cancer it is.i have had it for 10 years.i have high blood pressue.last year it dried and dropped off and it grew back.its been growing for years.and ulcerated.if you think its cancer what type and name it is?what scan tests to do?how much an operation to remove would cost private and what country is cheepest?do you recommend any surgeons in italy?there has been an ulcer there for10 years.would like as much information about what u think it is.if you think it can be a few different things.plz let me know...not sure what the query subject should be,its lip related,if cancer you know.thanks
Posted Sun, 10 Mar 2013 in Cancer
Answered by Dr. Kalpana Pathak 1 hour later
Thanks for writing to us.
From the pictures I can see ulceration and crusting over lower lip with an overlying protruding structure.
To answer your queries specifically
1)It could probably be a CUTANEOUS HORN overlying SQUAMOUS CELL CARCINOMA of the lower lip. Lower lip is prone to chronic sun injury and along with history of chronic smoking, there is a strong predisposition for malignancy of lower lip. Squamous cell carcinoma should be differentiated from KERATOACANTHOMA. As such cutaneous horn may present as a benign lesion but an underlying lip ulcer since 10 years points towards malignant change
2)The diagnosis is confirmed by biopsy of the lesion.
3) treatment is basically surgical excision of involved and a part of surrounding area followed by suturing. Radiation therapy may be required depending on the stage of cancer
I would not advise you to go to some other country to get the surgery done. Get it done in Italy as surgery required is a common one. Being a doctor based in India it is difficult to brief on cost of surgery.

Hope that answers most of your query.
Should there be any doubt, feel free to write back.

Ps should there be no other query, we may close the discussion.
Above answer was peer-reviewed by
Follow-up: Have high blood pressure, dark, dry and peeling lips. Should I be worried for cancer? 3 hours later
so ur sayings its most likely to be CUTANEOUS HORN overlying SQUAMOUS CELL CARCINOMA?
is this operation surgical excision of involved and a part of surrounding area followed by suturing,is this done while im awake?
is a biopsy done awake?what does.
what does this mean: predisposition for malignancy of lower lip...
so you don't think it can be anything else?
could it be just a cutaneous horn and not cancer?
does a biopsy mean cutting the whole horn and the underneath?
can you tell me what is the name of the type of lip scan they can do for this?
i have been picking on this by trying to take it off my lip,so i could have made it worse.please answer all questions as clearly as possible.should treatment be done in the uk or somewhere else?thanks
Answered by Dr. Kalpana Pathak 26 minutes later
Biopsy and surgical excision is always done under local anaesthesia. Local anaesthesia means that the area to be treated is made numb by giving injection of a local anaesthetic drug. Once the drug has been injected at the area of procedure( in your case lip), patient would not feel pain. Biopsy involves taking a small section of the lesion. Whenever a surgical excision or biopsy is done, it is done in a way to maintain normal shape of the area involved as much as possible.

The diagnosis I have suggested is based on visual examination and chronic persistence of ulcer. However, one can be sure only after biopsy proves the same thing.
It can just be a cutaneous horn without any malignant change but as there is ulceration underneath, a biopsy to rule out any malignancy is necessary for patient's benefit
Predisposition for malignancy means that chances to get a cancerous lesion is high. Any persistent cheilitis, chronic sun exposure, smoking, ulcer of lower lip is strong risk factor for squamous cell carcinoma.

In your case a biopsy is indispensable or mandatory. CT scan or MRI can be done to see the extent of involvement if biopsy proves any malignancy.

Do not pick the lesion as it would make it worse but the same cannot be implicated for a persisting ulcer of long duration and a cutaneous horn.

I would advise you not to panic but at the same time not to delay a doctor's visit as your case requires proper investigation. I would still say whatever I have suggested as a diagnosis is based on history and after having a look at the images sent by you. It may or may not be malignant.But any delay may prove to be harmful It is imperative to get the same confirmed by a thorough clinical examination by a surgeon. You can take treatment in UK, you don't need to move anywhere to get the lesion diagnosed and treated.


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Follow-up: Have high blood pressure, dark, dry and peeling lips. Should I be worried for cancer? 48 hours later
so your saying its not KERATOACANTHOMA for definate
local anaesthetic is done awake?
is there such a scan just done on lips?
wouldnt it be easier to operate to remove it and sending that sample off for testing as the person who has this doesnt want it on his lip.
this man left his cigarette on his lip and burnt his lip,he forgot to take it off.
he used many creams,scratched it
the horn growns and drops off then grows again.
can this be catching?can it be a hpv?if the guy is a smoker of so many years?
whats would you say are reasonable costs in the uk for mri,cat scans,full blood count,consultations,biopsy,operation,and reconstrucion.
sorry i have asked for costs and the consultants only giv eme some costs for consultation,biopsy and scans but not operation cost until after if i see one consultant&he tells me a high price than the other then i have to pay the same consultation costs to see a new company to be told operation fees.from your experience list me what you call not bad prices...
in your experience how many percentage chance of CUTANEOUS HORNs can be cancerous?what is what you would call ok costing of radiotherapy and chemotherapy?can you advise on any uk specialists?
Answered by Dr. Kalpana Pathak 5 hours later
Thanks for writing back. It is always a pleasure clearing doubts of people.

Firstly I would like to say whether a skin lesion is malignant or not can only be decided by skin biopsy. A skin examination can only propose it as a possibility.
I put forth a diagnosis of cutaneous horn with a possibility of underlying malignancy just to be on the cautious side as it was in patient's interest as its always safe than being sorry specially when ulceration of lip lesion is persistent since prolonged time. If at all it is malignancy, the type can only be decided by biopsy( that is whether it is squamous cell carcinoma or keratoacanthoma). The diagnosis suggested is in no way to make you panic.

Now cutaneous horn can be seen in smokers due to cigarette burn but squamous cell carcinoma too has chronic smoking and smoke burn as its causative factor. Cutaneous horns are usually benign but malignancy can be seen in 20 to 3o percent cases. So doesn't this percentage call for a specialist opinion. Cutaneous horns have a history of falling spontaneously and recurring again. HPV infections can lead to cutaneous horn however in this case it seems doubtful and cutaneous horn does not spread to other people as infection.

Local anaesthesia is given through a very fine needle and does not cause any pain whatsoever and renders the procedure painless too. Surgical excision followed by sending the specimen as a whole for biopsy can be done in a single sitting

Diagnosis requires a skin biopsy. No lip scan is required. CT, MRI will only be required as lip scan if at all the lesion is malignant. If it is not malignant, it would not be required.
Moreover skin biopsy is a cheaper procedure than scans.
I really cannot comment on the costing of procedures in UK. I am sorry for that.initially just a surgical excision and sending the same for biopsy is required which is not a costly procedure. The question of radio or chemotherapy arises later only if at all there is a malignancy.

I would recommend a doctors visit without a delay but at the same time expect you to visit with a positive mind as the diagnosis I have suggest is based on history and examination and the discussion whether its malignant or benign is futile unless you get it biopsied. The diagnosis suggested was just to make you aware of a possibility and it was in no way to make you anxious or panicky.

Still a doctor's visit should be planned at least for consultation and biopsy as early as possible.
I guess I have answered all the queries and further queries can only be answered after a proper investigation
Wish you a speedy recovery.

Above answer was peer-reviewed by
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