Derm Dx: Scaling on the lower lip - Clinical Advisor

Derm Dx: Scaling on the lower lip

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  • Actinic cheilitis_0114 Derm Dx

A 65-year-old Caucasian male complains of scaling on his lower lip. He has a history of basal cell carcinoma of the temple, which was treated with Mohs surgery two years ago.

Actinic cheilitis is due to long-term sunlight exposure. The condition occurs commonly in white men. The lower lip is involved to a much more significant degree than the upper lip, which is usually spared. The lip vermillion appears scaly, atrophic...

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Actinic cheilitis is due to long-term sunlight exposure. The condition occurs commonly in white men. The lower lip is involved to a much more significant degree than the upper lip, which is usually spared. The lip vermillion appears scaly, atrophic and may become fissured.

Patients with actinic cheilitis are a risk of developing squamous cell carcinoma (SCC).  Biopsy demonstrates partial thickness atypia of the epidermis. Hence, actinic cheilitis is considered a premalignant condition. 

Treatment of actinic cheilitis includes cryotherapy, application of topical imiquimod or 5-fluorouracil, photodynamic therapy, ablative laser surgery or vermillionectomy. Any thickened and persistent areas should be biopsied to rule out SCC. All patients should be advised to avoid sun and use a sunscreen containing lip balm. 

Other answer choices:                                     

Allergic contact cheilitis is allergic contact dermatitis involving the lip. Edema, fissuring, crusting and vesiculation are characteristic. Women are affected much more frequently than men, with the majority of cases attributable to lipstick. 

Other causes of contact cheilitis include, but are not limited to: lip balms, sunscreens, toothpaste and other dental-care products, nickel and the skin of mangoes.

Cheilitis granulomatosa, also called granulomatous cheilitis, is an idiopathic non-infectious granulomatous disorder of the lips. It is characterized by chronic, persistent, and diffuse enlargement of the lips. 

Fordyce spots are ectopic sebaceous glands located in the lip. 

Adam Rees, MD, is a graduate of the University of California Los Angeles School of Medicine and a resident in the Department of Dermatology at Baylor College of Medicine also in Houston.

Keyan Matinpour, MD, is a dermatology resident at Baylor College of Medicine.

References

  1. Bolognia J, Jorizzo JL and Rapini RP. “Chapter 72: Oral Disease.” Dermatology. St. Louis, Mo.: Mosby/Elsevier, 2008. Print.
  2. James WD, Berger TG, Elston DM et al. “Chapter 34: Disorders of the Mucous Membranes.” Andrews’ Diseases of the Skin: Clinical Dermatology. Philadelphia: Saunders Elsevier, 2006. Print.
  3. Freeman S, Stephens R. Cheilitis: analysis of 75 cases referred to a contact dermatitis clinic. Am J Contact Dermat. 1999;10(4):198-200.
  4. Leao JC, Hodgson T, Scully C et al. Review article: orofacial granulomatosis. Aliment Pharmacol Ther. 2004;20(10):1019-27.
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