Pediatric SCC of the upper lip triggered following excision of a long-standing scar

Introduction and importance: Oral squamous cell carcinoma (SCC) is exceptionally rare in patients under 40, with chronic sun exposure being a primary risk factor. This report presents a highly unusual case of pediatric SCC of the upper lip in the Middle East, notable for its atypical location and absence of all conventional risk factors. Presentation of case: A 13-year-old, otherwise healthy Syrian boy presented with a progressive swelling on his upper lip. The lesion appeared 1 week after the surgical excision of a traumatic scar that had persisted for 6 years. The swelling failed to respond to conventional treatments over a 2-month period. Histopathological examination confirmed poorly differentiated squamous cell carcinoma. Clinical discussion: The patient was treated with wide surgical excision employing 1 cm safety margins, followed by reconstruction using an Abbe flap and adjuvant chemoradiotherapy. Over a 2-year follow-up period, no recurrence was observed, with excellent outcomes. This case is exceptional: it contrasts with the typical presentation of lip SCC in the elderly and its predominant occurrence on the lower lip. Furthermore, the development of SCC at the site of a long-standing scar highlights potential malignancy arising from chronic inflammation and trauma. Conclusion: This report documents a rare instance of pediatric upper lip SCC, underscoring the importance of considering malignancy in persistent or evolving lesions, even in young patients without traditional risk factors. It emphasizes that chronic scarring should be recognized as a potential risk factor for carcinogenesis.