Actinic Cheilitis

Definition

Actinic cheilitis is a chronic degenerative disorder of the lower lip (with sparing of the commissures). This is a type of actinic keratosis which classically occurs on the lower lip and is directly related to long-term sun exposure.

Ætiology

Long-term exposure to sunlight.

Clinical Features

In the early stage, mild erythema (reddening) and œdema (swelling) followed by dryness and fine scaling of the lower lip vermilion border (the junction between the lip and skin) are the presenting signs.

As the lesion progresses, the epithelium (skin) becomes thin and smooth, with small whitish gray areas intermingled with red regions and scaly formations. Erosions (ulcers) and tiny nodules may develop.

The vermilion appears atrophic (thinned) and pale with a glossy surface and loss of demarcation at the vermilion border. With progression, fissuring and ulceration can occur along with crusting or scaling. Epithelial atrophy and elastosis are seen histologically and these changes are irreversible. Areas of persistent ulceration should be biopsied due to a 6 – 10% rate of malignant transformation.

The lesion is pre-malignant and usually occurs in fair-skinned men over 50 years of age, 4 – 8th decade of life and who have had outdoor jobs / activities.

Laboratory Tests

Histo-pathological examination.

Differential Diagnosis

The following conditions should be considered before making a diagnosis of actinic cheilitis:

Leukoplakia
Lichen Planus
Lupus erythematosus
early Oral Squamous Cell Carcinoma
Cheilitis due to radiation.

Treatment

Protection of lips from sunlight. Vermilionectomy in severe cases. Treatment of malignancy is primarily surgical; however, a trial of topical chemotherapy with 5-fluorouracil can be used with early lesions.

Prophylactic laser ablation or vermillionectomy may be performed in cases where malignant transformation has not yet occurred.

Close long-term follow-up is indicated, as these patients are at risk for additional cancers associated with solar damage.