A 72-year-old white man complained of redness, soreness, and irritation of his lower lip for more than 10 years. Physical examination revealed a diffuse erythematous crusted patch involving the lower lip, with a 1.2-cm centrally located palpable area (Fig 1). Cervical adenopathy was not noted. A biopsy performed in 1981 showed actinic keratosis, and the area was treated with liquid nitrogen and fluorouracil. In 1985, two lip biopsy specimens showed squamous cell carcinoma in situ, and actinic keratosis with severe dysplasia, for which he was treated with liquid nitrogen. Several lip biopsy specimens obtained in 1988 demonstrated ulcerated squamous cell carcinoma, Broder's grade 1. The tumor was 0.9 cm at its greatest depth.
At about the same time, a 2-cm noncalcified nodule in the right middle lobe was seen on a chest roentgenogram ordered as preoperative screening for cataract surgery, and it was feared that squamous cell carcinoma had metastasized