Clinical Manifestations

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.1,2,12,21,22,36 In its early stages, SC presents as a dry, scaly unobtrusive “chapped lip.” Palpation provides a sense of rubbing the fingers over sandpaper.37 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.1,22,38

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.21,39 Figures 1-8 document the progression of labial UVR damage from acute sunburn to primary and recurrent invasive SCC.

Figure 1. Blistering secondary to acute exposure to UVR.
Blistering secondary to acute exposure to UVR
Figure 2. Solar cheilosis presenting as a dry, scaly, unobtrusive “chapped lip.”
Solar cheilosis presenting as a dry, scaly, unobtrusive chapped lip
Figure 3. Solar cheilosis characterized by marked parallel folds and loss of elasticity.
Solar cheilosis characterized by marked parallel folds and loss of elasticity
Figure 4. Isolated areas of crusting and loss of definition of the vermilion border - biopsy-proven moderate dysplasia.
Isolated areas of crusting and loss of definition of the vermilion border - biopsy-proven moderate dysplasia
Figure 5. White/gray opalescent plaques of the vermilion - biopsy proven severe dysplasia.
White/gray opalescent plaques of the vermilion - biopsy proven severe dysplasia
Figure 6. Waxing and waning erythematous ulceration with induration - biopsy-proven carcinoma-in-situ.
Waxing and waning erythematous ulceration with induration - biopsy-proven carcinoma-in-situ
Figure 7. Persistent ulceration with induration and recent onset of pain - biopsy-proven invasive SCC.
Persistent ulceration with induration and recent onset of pain - biopsy-proven invasive SCC
Figure 8. Biopsy-proven recurrent SCC with ulceration and induration 10 years after excision of primary SCC.
Biopsy-proven recurrent SCC with ulceration and induration 10 years after excision of primary SCC