Actinic Cheilosis (Cheilitis)



Quick Summary
Introduction
References
Photos



Clinical Features
Histopathology
Treatment
Prognosis

  Smooth lower lip vermilion has large leukoplakia lesion with small midline chronic ulcer.

 

 


 

Quick Review for Patients

 
Actinic cheilosis is a diffuse degenerative change of the lower lip as a result of sun damage.  It occurs primarily in men and does not present until after 50 years of age, but the cause is often extreme sun exposure during the teen years and young adult life.  Life-time occupational sun exposure increases the risk.  The lip becomes puffy and blotchy red and pale pink, with occasional white plaques (leukoplakia) and chronic ulcers.  This is a precancer, with an estimated 6% risk of cancer development.  Treatment is close follow-up and removal of thick white or white/red patches or nonhealing ulcers.  Extensive lesions require complete removal of the lip mucosa and replacement with mucosa inside the mouth.

 

 

 

Introduction

Note: click on underlined words for more detail or photos.

Actinic cheilosis (actinic cheilitis) is a diffuse, degenerative, irreversible alteration of the vermilion border of the lips which results from excessive exposure to ultraviolet light. It primarily affects persons with light complexions, especially those with a tendency to sunburn easily.


Clinical Features

Actinic cheilosis is a disease of persons older than 50 years of age and its frequency increases with advancing age thereafter. The male:female ratio is as high as 10:1 in some studies. Almost all cases occur on the lower lip vermilion, probably because of the more direct sunlight exposure of that site.

The labial changes develop so slowly that the patient is frequently unaware of a change, beginning with mild puffiness and vermilion atrophy with admixed blotchy areas of pallor and erythema, perhaps with a bluish background hue (Figures 1 & 2). The normal demarcation between the vermilion zone and the skin of the lip becomes blurred or disappears (Figure 3). As the lesion progresses, rough, scaly areas develop on the drier portions of the vermilion, appearing is some cases as leukoplakia (Figure 4). Painless ulceration may develop in one or more sites, especially in areas of mild trauma. Ulcers may last for months, even years, and may be difficult to differentiate from ulcerated squamous cell carcinoma, although the latter is typically more indurated. Ulcers more than two months old should be biopsied in order to evaluate for malignancy.


Pathology and Differential Diagnosis


 
Atrophic stratified squamous epithelium is seen, often with marked parakeratin production and possibly with epithelial dysplasia of the basal and parabasal layers. Rete ridges may be lost. The subepithelial stroma invariably demonstrates an amorphous, acellular, lightly basophilic change (solar elastosis, actinic elastosis) from the ultraviolet light-induced breakdown of collagen fibers (Figures 5-7). Fibrovascular tissues above and below the elastosis are often scattered with lymphocytes. The lower margin of the elastosis is relatively uniform throughout the lip, but areas of involvement may be separated laterally by less damaged stroma.


Treatment and Prognosis

 

Actinic cheilosis is an irreversible change and squamous cell carcinoma, almost always well-differentiated, develops in 6-10% of cases. Malignant transformation seldom occurs prior to 60 years of age and the resulting carcinoma typically enlarges so slowly and metastasizes so late that one population study found no deaths and minimal morbidity from the carcinomas.

Follow-up is recommended and patients should use lip balm with sunscreens in order to prevent further degeneration. Occurrence of induration, thickening, ulceration, or leukoplakia should lead to biopsy for histopathologic evaluation. In severe cases without malignancy, a lip shave procedure (vermilionectomy) can remove the vermilion mucosa and replace it with a portion of the intraoral labial mucosa.


References (Chronologic Order)

Note: Click on underlined author's names for additional detail.

General references:

Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and maxillofacial pathology. Philadelphia, W. B. Saunders; 1995.

Elder D, Elenitsas R, Jaworsky C, Johnson B Jr. Lever's Histopathology of the skin, 8th edition. Philadelphia; Lippincott-Raven, 1997.

Sapp JP, Eversole LR, Wysocki GP. Contemporary oral and maxillofacial pathology. Mosby; St. Louis, 1997.

Odell EW, Morgan PR. Biopsy pathology of the oral tissues. London; Chapman & hall Medical, 1998.

Specific references:

Schmitt C, Folsom T. Histologic evaluation of degenerative changes of the lower lip. J Oral Surg 1968; 26: 51-56. Cataldo E, Doku HC. Solar cheilitis. J Dermatol Surg Oncol 1981; 7: 989-993.

Piscascia DD, Robinson JK. Actinic cheilitis: a review of the etiology, differential diagnosis, and treatment. J Am Acad Dermatol 1987; 17: 255-264.

Manganaro AM, Will MJ, Poulous E. Actinic cheilitis: a premalignant condition. Gen Dent 1997; 5:492-494.

Dufresne RG Jr, Curlin MU. Actinic cheilitis. A treatment review. Dermatol Surg 1997; 23:15-21.

Wright K, et al. Actinic cheilitis. Dermatol Surg 1998; 24:490-491.


Pictures

Note: To see enlarged photo, click on the left-hand picture; 
return here with your BACK ARROW button.