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Malignant melanoma of the vermilion of the lip is a rare entity, and because of the common occurrence of other benign pigmented lesions, it is easily overlooked. Early diagnosis is of the utmost importance, in the first instance to minimise the risk of haematogenous, lymphatic, perineural and trans- (salivary) ductal spread. The second reason for early diagnosis is that surgery is the only effective form of treatment. A number of important clinical lessons were learned from this cohort study of malignant melanoma of the vermillion of the lip. Two observations are of note - first, the absence of palpable regional lymph nodes does not exclude the presence of a malignant melanoma, yet all patients presenting with palpable nodes were suffering from a preterminal disease. Secondly, apart from 1 case (our case 2), melanoma of the lip seems to occur on the lower lip only. There are no clear guidelines regarding the necessary extent of extirpation for malignant melanoma of the vermilion of the lip, but we propose that clear margins of less than 10 mm are probably inadequate and margins of more than 20 mm are unnecessary. Concern about a resection resulting in a 20 mm clear margin all round is seldom justified as excellent methods of reconstruction achieving acceptable mobile, adequately sensate lips are available.

Serum testosterone levels in South African men and the onset of androgen decline in ageing males.