Patient information: A 51-year-old female presented to our clinic with a large, painful lesion on her lower lip, which had been slowly increasing in size.

Medical history: Past medical history: negative. Past surgical history: negative. Social history: no smoking history.

Clinical findings: On examination, the patient had a thick, rough scale patch involving the entire lower lip and the angle of the mouth, with signs of crusting and bleeding. There were no signs of squamous cell carcinoma (SCC) elsewhere on the face. On neck examination, palpable lymph nodes were noted in both the submandibular region and the left side of the neck.

Diagnostic assessment: Sonography of the neck revealed pathological lymph nodes in both the right and left submandibular regions, measuring 22 mm and 15 × 12 mm, respectively. Additionally, a left upper cervical pathological lymph node was identified, measuring 20 × 13 mm. CT scan of the head, neck, chest, and upper abdomen revealed a bulky lower lip cutaneous neoplasia with muscle invasion, along with bilateral locoregional cervical suspicious lymph nodes and bilateral axillary and abdominal suspicious lymph nodes.

FNAC of the lower lip lesion confirmed squamous cell carcinoma. FNAC of cervical lymph nodes confirmed metastatic squamous cell carcinoma. Axillary FNAC was negative for malignancy but showed non-necrotizing granulomatous lymphadenitis.

Treatment: Due to the extensive disease, the patient was managed with palliative care.