Quick Review for Patients
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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.
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
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.
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.
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.
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