Surgical Management of Advanced Lip Tumors: Analysis of 30 Cases with Oncologic, Reconstructive and Socioeconomic Correlates

Background: Lip cancers, predominantly squamous cell carcinoma (SCC), represent 15–30% of oral cavity malignancies, with advanced presentations common in Northern Africa due to healthcare access limitations, cultural practices (e.g., traditional pipe smoking), and high UV exposure. This study evaluates the surgical management of advanced lip tumors (T3–T4), focusing on oncologic, reconstructive, and socioeconomic outcomes. Methods: A retrospective analysis of 30 patients (2017–2023) from a Moroccan tertiary center was conducted. Surgical protocols included frozen-section-guided resection (five-quadrant sampling, 89% concordance with final pathology) and defect-specific reconstruction (W-plasty, Eslander, Webster-Bernard, or modified Karapandzic flaps). The modified Karapandzic technique prioritized neurovascular preservation (3.4 ± 0.8 bundles retained) and three-layer closure. Outcomes were assessed via oral competence scores, recurrence rates, and survival analysis. Results: The cohort exhibited female predominance (86%), late-stage presentation (77% T4 tumors), and high-risk factors (91% chronic sun exposure, 78% tobacco use). Reconstructive outcomes favored the modified Karapandzic technique (oral competence: 7.5/10 vs. 5.8/10 classic; *p* = 0.003), though microstomia remained a challenge (28–41%). Two-year disease-free survival was 78% (Stage III) and 52% (Stage IVA), with perineural invasion (HR 3.2) and margins <5 mm (HR 4.7) predicting recurrence. Socioeconomic barriers included diagnostic delays (median 19 months) and limited adjuvant therapy access (40% incomplete radiotherapy). Conclusion: Advanced lip tumors in resource-limited settings require tailored approaches balancing radical resection and functional preservation. The modified Karapandzic technique improves outcomes, but public health interventions (e.g., community screening, subsidized care) are critical to address disparities in late-stage presentation.