BMJ Case Reports 2017; doi:10.1136/bcr-2017-219771

Successful treatment of squamous cell carcinoma of the lip with electron beam therapy: a symphony of medicine and physics

  1. Sandeep Rathour
  1. Department of Radiation Oncology, Batra Hospital & Medical Research Centre, New Delhi, India
  1. Correspondence to Dr Irfan Ahmad, irfan.a{at}
  • Accepted 7 April 2017
  • Published 21 April 2017


A female aged 57 years, a professional flautist by occupation presented with a history of non-healing ‘pimple’ on her left upper lip, which was gradually increasing in size over 6 months. There was history of occasional yellowish discharge and bleeding, provoked by her attempts to remove it. On examination, there was a firm non-tender swelling with fine, white crusting, measuring 5 mm at its widest along with surrounding induration of 1 cm (figure 1A), without involvement of the inner mucosa of lip.

Figure 1

Pretreatment and post-treatment images. (A) The visible lesion (black arrow) was surrounded by a 1 cm circumferential region of induration (white arrow) appreciated on palpation. These were marked on patients skin and a 2 cm margin (blue arrow) was also marked to serve as the planning target volume. Care was taken to exclude the nasal ala from this volume. To ensure reproducibility a custom treatment setup was devised by our radiation technologist, which included a sterile styrofoam block to keep the mouth open. A sterile rubber-coated flexible lead shield of 5 mm thickness was then placed over the teeth, snugly fitting the gingivo-buccal sulcus. Finally, a custom-moulded sterile wax sheet measuring 1 cm in thickness was interposed between the mucosa of upper lip and the lead shield. Care was taken to ensure that the treatment surface was as even as …

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