Actinic Cheilosis: Etiology, Epidemiology, Clinical Manifestations, Diagnosis, and Treatment
Course Number: 400
UVR-induced damage to the lip may be acute, resulting in sunburn, blistering or peeling; chronic exposure leads to SC, primarily of the lower lip. 1,2,12,21,22,31 In its early stages, SC presents as a dry, scaly unobtrusive “chapped lip.” Palpation provides a sense of rubbing the fingers over sandpaper.32 At later stages small nodules; marked parallel fissuring; mottled, opalescent white or gray plaques; erosion or ulceration along with crusting; as well as loss of definition of the lip vermilion are noted.1,32-34
The clinical appearance of SC does not always correlate directly with underlying histological changes and an apparently suspicious lesion may prove to be benign, while a perceived benign lesion may in fact represent severe dysplasia or even SCC.1 Waxing and waning of erythematous or ulcerative areas with evidence of induration and pain are ominous signs.35,36 Figures 1-8 document the progression of labial UVR damage from acute sunburn to primary and recurrent invasive SCC.
Blistering secondary to acute exposure to UVR.
Solar cheilosis presenting as a dry, scaly, unobtrusive “chapped lip.”
Solar cheilosis characterized by marked parallel folds and loss of elasticity.
Isolated areas of crusting and loss of definition of the vermilion border - biopsy-proven moderate dysplasia.
White/gray opalescent plaques of the vermilion - biopsy proven severe dysplasia.
Waxing and waning erythematous ulceration with induration - biopsy-proven carcinoma-in-situ.
Persistent ulceration with induration and recent onset of pain - biopsy-proven invasive SCC.
Biopsy-proven recurrent SCC with ulceration and induration 10 years after excision of primary SCC.