Actinic (Solar) Cheilitis
Etiology • Chronic, excessive exposure to solar radiation; ultraviolet
spectrum (ranging from 290 to 320 nm) most damaging • Fair-complexioned people more severely affected than others • May progress to cutaneous actinic keratosis and/or squamous
cell carcinoma
Clinical Presentation • Vermilion portion of lower lip • Pale irregularly opaque (keratotic) surface with intervening red
(atrophic) zones • Obfuscated to effaced cutaneous-vermilion border • More advanced lesions are scaly, crusted and/or indurated. • Progression to carcinoma often heralded by persistent
ulceration or erosion
Microscopic Findings • Hyperkeratosis • Epithelial atrophy • Variable degrees of epithelial dysplasia • Amphophilic to basophilic change in submucosa (elastosis) • Telangiectasia
Diagnosis • Thermal/chemical burn ruled out by history • Chronic ultraviolet light exposure • Biopsy findings
Differential Diagnosis • Exfoliative cheilitis • Squamous cell carcinoma
Etiology • Chronic, excessive exposure to solar radiation; ultraviolet
spectrum (ranging from 290 to 320 nm) most damaging • Fair-complexioned people more severely affected than others • May progress to cutaneous actinic keratosis and/or squamous
cell carcinoma
Clinical Presentation • Vermilion portion of lower lip • Pale irregularly opaque (keratotic) surface with intervening red
(atrophic) zones • Obfuscated to effaced cutaneous-vermilion border • More advanced lesions are scaly, crusted and/or indurated. • Progression to carcinoma often heralded by persistent
ulceration or erosion
Microscopic Findings • Hyperkeratosis • Epithelial atrophy • Variable degrees of epithelial dysplasia • Amphophilic to basophilic change in submucosa (elastosis) • Telangiectasia
Diagnosis • Thermal/chemical burn ruled out by history • Chronic ultraviolet light exposure • Biopsy findings
Differential Diagnosis • Exfoliative cheilitis • Squamous cell carcinoma
Treatment • Prevention of further damage with sunscreens blocking long-wave ultraviolet A (UVA) and short-wave ultraviolet B (UVB) light
• Biopsy of clinically suspicious areas •CO 2
laser vermilionectomy • Topical 5-fluorouracil or vermilionectomy for severe disease • Excision or resection-reconstruction if malignant
transformation has occurred
Prognosis • Lifelong follow-up • Up to 10% develop into squamous cell carcinoma. • When carcinoma develops, growth tends to be slow and
metastasis occurs late; 85 to 90% long-term survival