A 79-year-old man, an 81-year-old woman and a 60-year-old woman were referred to our oral and maxillofacial surgery clinic with a large submandibular swelling. All three patients had a history of prior excision of a small carcinoma of the lower lip. Primary treatment had been carried out by a number of different medical specialists. In the first two patients, none of the caregivers had recognized this swelling as a possible lymph node metastasis. Oncological follow-up had not been performed and the patients were unaware of the metastatic potential of their cancers. Although in the third patient follow-up was adequate, there was too much delay between confirmation of the metastasis and planning of the surgery. All three patients died of a small lip carcinoma. Stage I lip carcinomas generally have a good prognosis. However, patients have to be informed about the risk of lymph node metastasis and need to be followed up on a routine basis.
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