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Patient concerns: An 82-year-old man presented with a mildly painful lesion on the right lower lip and denied gastrointestinal symptoms. Diagnoses: Shave biopsy showed adenocarcinoma; PET/CT suggested esophageal malignancy with metastatic disease. Interventions: EGD found a distal esophageal lesion; biopsy confirmed invasive, moderately to poorly differentiated EAC. Outcomes: Stage IV metastatic disease; chemotherapy started and well tolerated. Lessons: Highlights rare lip-only presentation without typical GI signs, stressing suspicion, early biopsy, and timely diagnosis.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/the-clue-is-on-the-lip-unmasking-esophageal-adenocarcinoma-a-case-report/370653/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/the-clue-is-on-the-lip-unmasking-esophageal-adenocarcinoma-a-case-report/370653.png","ImageObject",300,407,{"name":92,"@type":93},"Bintang","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What symptom led to the initial discovery of esophageal adenocarcinoma in this case?","Question",{"text":112,"@type":113},"An 82-year-old man presented to dermatology with a mildly painful lesion on the right lower lip. He denied prior gastrointestinal symptoms.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was the diagnosis confirmed?",{"text":117,"@type":113},"A shave biopsy of the lip lesion revealed adenocarcinoma, and PET/CT raised concern for esophageal malignancy with metastatic disease. Esophagogastroduodenoscopy then identified a distal esophageal lesion, and biopsy confirmed invasive, moderately to poorly differentiated esophageal adenocarcinoma.",{"name":119,"@type":110,"acceptedAnswer":120},"Why is this case considered clinically important?",{"text":121,"@type":113},"It demonstrates a rare presentation of stage IV esophageal adenocarcinoma as a solitary lip lesion without typical gastrointestinal symptoms. It emphasizes maintaining a high index of suspicion for systemic malignancy in atypical skin lesions and the need for early biopsy and diagnosis.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},370653,1790249709,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":52},962085564381,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","®  \n Clinical Case Report   \nThe clue is on the lip: unmasking esophageal adenocarcinoma  \nA case report  \nAbuoma Cherry Ekpendu, DOa ,* , Muhammad Sohaib Asghar, MBBSa , Gregory May, DOa , Thomas Jewell, MDb , Pankajkumar Patel, MDc  \n\n| Abstract\u003Cbr>Rationale: Esophageal cancer accounts for about 1% of all cancer diagnoses in the United States.\u003Cbr>Patient concerns: An 82-year-old male presented to a dermatology clinic with a chief complaint of a skin lesion on the right lower lip. He denied any prior gastrointestinal symptoms or history.\u003Cbr>Diagnoses: A shave biopsy of the lip lesion revealed adenocarcinoma. Subsequent positron emission tomography–computed tomography demonstrated findings concerning for esophageal malignancy with metastatic disease.\u003Cbr>Interventions: Esophagogastroduodenoscopy identified a lesion in the distal esophagus, and biopsy confirmed invasive, moderately to poorly differentiated esophageal adenocarcinoma.\u003Cbr>Outcomes: The patient was referred to oncology, where he was diagnosed with stage IV metastatic esophageal adenocarcinoma. He was initiated on chemotherapy, which he tolerated well.\u003Cbr>Lessons: This case highlights the rare presentation of stage IV esophageal adenocarcinoma as a solitary lip lesion without typical gastrointestinal symptoms. Given the rarity of lip involvement, clinicians should maintain a high index of suspicion for systemic malignancy in atypical skin lesions. Early biopsy and diagnosis are crucial for timely intervention and improved outcomes. The purpose of the study is to highlight the importance of maintaining a high index of suspicion for gastrointestinal malignancy, even in the absence of traditional gastrointestinal symptoms, when evaluating unusual skin lesions.\u003Cbr>Abbreviations: EAC = esophageal adenocarcinoma, EGD = esophagogastroduodenoscopy, FOLFOX = leucovorin calcium, fluorouracil, and oxaliplatin, PET/CT = positron emission tomography-computed tomography. |\n| --- |\n| Keywords: adenocarcinoma, esophageal cancer, esophagogastroduodenoscopy, lip lesions |\n\n1. Introduction  \nEsophageal cancer accounts for approximately 1% of all cancer diagnoses in the United States, though its prevalence is higher in certain regions, including northern China, Southeast Asia (such as India), southern Africa, and Iran.[1] In 2024, an estimated 22,370 new cases of esophageal cancer were diagnosed, with approximately 16,130 deaths attributed to the disease. Among these, 17,690 new cases and 12,880 deaths occurred in men, while 4680 new cases and 3250 deaths were reported in women. Esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma are the 2 most common histological subtypes of esophageal cancer.  \nThe incidence of esophageal cancer varies by race and ethnicity. It is more common in the White population, where EAC  \nis the predominant histologic subtype. In contrast, squamous cell carcinoma is more prevalent among African Americans. American Indians, Alaska Natives, and Hispanics have lower rates of esophageal cancer, while the lowest incidence is observed among Asians and Pacific Islanders. [1] Most patients with EAC present at an advanced stage, contributing to poor prognosis. [2]  \nReports of EAC metastasizing to the lip are exceedingly rare. This case report aims to highlight the rare and unique presentation of Stage IV EAC manifesting as a solitary lip lesion, in the absence of typical gastrointestinal symptoms. It underscores the need for clinicians to maintain a high index of suspicion for systemic malignancy when evaluating atypical skin lesions. Additionally, it raises awareness of this uncommon metastatic  \nWritten Informed consent was secured from the patient.  \nThe authors have no funding and conflicts of interest to disclose.  \nData sharing not applicable to this article as no datasets were generated or analyzed during the current study.  \nOur study received proper ethical oversight and approval from the hospital ethical and risk review committee (Instituti","cbCaic0UJqlyt36R","https://ap.wps.com/l/cbCaic0UJqlyt36R","pdf",551628,"English","# Abstract\n## Rationale\n## Patient concerns\n## Diagnoses\n## Interventions\n## Outcomes\n## Lessons\n# Introduction\n# Case presentation","[{\"question\":\"What symptom led to the initial discovery of esophageal adenocarcinoma in this case?\",\"answer\":\"An 82-year-old man presented to dermatology with a mildly painful lesion on the right lower lip. He denied prior gastrointestinal symptoms.\"},{\"question\":\"How was the diagnosis confirmed?\",\"answer\":\"A shave biopsy of the lip lesion revealed adenocarcinoma, and PET/CT raised concern for esophageal malignancy with metastatic disease. Esophagogastroduodenoscopy then identified a distal esophageal lesion, and biopsy confirmed invasive, moderately to poorly differentiated esophageal adenocarcinoma.\"},{\"question\":\"Why is this case considered clinically important?\",\"answer\":\"It demonstrates a rare presentation of stage IV esophageal adenocarcinoma as a solitary lip lesion without typical gastrointestinal symptoms. It emphasizes maintaining a high index of suspicion for systemic malignancy in atypical skin lesions and the need for early biopsy and diagnosis.\"}]","The clue is on the lip - unmasking esophageal adenocarcinoma - A case report | PDF",1790189663]