Actinic, or solar, cheilitis (Figure 1) represents accelerated tissue degeneration of the vermilion (dry mucous membrane) of the lips (The vermilion border is the normally sharp demarcation between the lip (red colored) and the adjacent normal skin), especially the lower lip, as a result of chronic exposure to sunlight; it is considered to represent a potentially premalignant condition as the radiant energy not only affects the epithelium, but also the superficial supporting connective tissue. This condition occurs almost exclusively in whites and is especially prevalent in those with fair skin.
- Clinical Features
The affected vermilion of the lips takes on an atrophic, pale to silver gray, glossy appearance, often with fissuring and wrinkling at right angles to the cutaneous vermilion junction (Figure 2).
Slightly firm, bilateral swelling of the lower lip is common. In advanced cases, the junction is irregular or totally effaced, with a degree of epidermization of the vermilion. Mottled areas of hyperpigmentation and keratosis are often noted, as well as superficial scaling, cracking, erosion, ulceration, and crusting (Figure 1). A loss of elasticity of the lips may also be noted.
Because of the positive relationship between exposure to UV light and carcinoma (cancer), lip protection is indicated. The use of the lip balm containing sunscreen agent such as para-aminobenzoic acid (PABA) or its derivative is indicated during periods of sun exposure in high-risk patients.
Sun blocking agents such as titanium oxide or zinc oxide provide complete protection from both ultraviolet A (UVA) and UVB rays.
Chronic sun damage mandates periodic examination and a biospy if ulceration persists or if induration occurs. If atypical changes (abnormal changes) are noted within the epithelium, a vermilionectomy (the surgical removal of the vermilion border) may be performed in association with mucosal advancement to replace the damage vermilion. This operation is associated with some morbidity (Adverse effects caused by a medical treatment such as surgery), primarily related to lip paresthesia (an abnormal sensation, typically tingling or pricking (“pins and needles”), caused chiefly by pressure on or damage to peripheral nerves on the lip), therefore prompting some to advocate wedge excision for suspicious lesions. Acceptable results are attainable with the use of laser surgery or cryosurgery, as well as with topical 5-flourouracil. Topical imiquimod, an immune stimulant, has been used with clearing of lesions noted within 4 weeks of treatment completion.
Etiology: Overexposure to ultraviolet light. Represents a premalignant lesion.
Clinical Features: Lower lip affected because of exposure to sun; upper lip usually with minimal change. More severe in light-skinned individuals. Atropic, finely wrinkled, and often swollen appearance of lip. Possible presence of white and/or pigmented foci. Poorly defined vermilion-skin junction. Possible chronic ulceration in more severely damaged lips.
Treatment: Avoidance of direct sunlight. Use of sunscreen/sun blocking agent. Biopsy of persistent ulcers and indurated lesions. Vermilionectomy possibly needed in problematic cases.
Reference: Oral Pathology, Sixth Edition, By Regezi, Sciubba, & Jordan.
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Haider Maitham, DDS