Lip resection

Background

Malignancies of the oral mucosa are most commonly squamous cell carcinomas but salivary gland neoplasms and neuroendocrine epithelial neoplasms can also occur.1 The extent of resection will depend on the size and location of the lesion. This protocol includes resection of tumours of the lip.


Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. See overview page for more detail on identification principles.

Fresh tissue received
  • No
    • Non-routine fixation (not formalin), describe.
  • Yes
    • Special studies required, describe.
    • Ensure samples are taken prior to fixation.
Intraoperative consultation
  • Not performed
  • Performed, describe type and result
    • Frozen section
    • Imprints
    • Other, describe

See general information for more detail on specimen handling procedures.

Inspect the specimen and dictate a macroscopic description.

External InspectionBack to top


Orientate and identify the anatomical features of the specimen.

Orientation markers

Record additional orientation or designation provided by operating clinician:

  • Absent
  • Present
    • Method of designation (e.g. suture, incision)
    • Describe orientation of the marker at cut-up (e.g. 12 o'clock)
    • Record any coloured inks applied and to which margin

Photograph the intact specimen if required.

Describe the following features of the specimen:

Procedure

Record as stated by the clinician.

Options
  • Wedge resection of lip
  • Other, specify

*See specific protocol for more detail on neck dissection specimens

Specimen laterality

  • Left
  • Right
  • Central

Specimen integrity

  • Intact
  • Disrupted

Anatomical components included (more than one may apply) and specimen size (mm)

Describe and measure the anatomical components present.2

  • Total specimen size in three dimensions, length x width x thickness

DissectionBack to top


Lip resections are generally described as “wedge” biopsies but can be quite rectangular in shape. The specimens have a vermillion border and a muscular core, and have outer skin and inner mucosal surfaces.3

Paint the margins with ink according to your laboratory protocol. In many laboratories the specimen is painted along one margin as a minimum. 

Please note painting protocols differ between laboratories.

  • Section lip resection specimens transversely, perpendicular to the vermillion border/free edge of lip, left to right, to demonstrate the full thickness of the lip lesion, with shave sections of the peripheral margins.3

Internal InspectionBack to top


Describe the internal or cut surface appearance including the following items:2

Tumour/lesion

  • Absent
  • Present
    • Number; if more than one, designate and describe each separately

Tumour size (mm)

Measure the tumour in three dimensions.
  • Length x width
  • Macroscopic depth of invasion*
*More detail

This is the depth of invasion below the mucosal/skin surface not the thickness of tumour. Ulcerated tumours should be measured from an estimate of the reconstructed surface.1

Distance of tumour to each margin (mm)

  • Distance to the peripheral resection margins, as designated

Photograph the dissected specimen if required.

Note photographs taken, diagrams recorded and markings used for identification

ProcessingBack to top


Dissect the specimen further and submit sections for processing according to the diagram provided.

Submit representative sections of:1

  • Peripheral margins (usually right and left lateral margins but may be superior and inferior if specimen is from side of mouth)
  • Transverse sections through tumour, demonstrating relationship with adjacent tissue and maximum depth of invasion

Record details of each cassette.

An illustrated block key similar to the one provided may be useful.

Block allocation key 

Cassette id
Site
No. of pieces
A
Right lateral margin
 
B-C
Tumour, transverse sections
 
D
Left lateral margin
 

Acknowledgements

Prof Richard Logan for his contribution in reviewing and editing this protocol.

ReferencesBack to top


  1. Helliwell T and Woolgar J. Dataset for histopathology reporting of mucosal malignancies of the oral cavity, The Royal College of Pathologists, London, 2013.
  2. Dahlstrom J, Coleman H, Johnson N, Salisbury E, Veness M and Morgan G. Oral structured reporting protocol, The Royal College of Pathologists of Australasia, Surry Hills, NSW, 2012.
  3. Slootweg PJ. Complex head and neck specimens and neck dissections. How to handle them. J Clin Pathol. 2005;58(3):243-8.