Actinic cheilitis is a precancerous lesion on the lip caused by chronic sun exposure. It can cause loss of the vermilion border, thickening, discoloration, and scale formation. It is more common in fair-skinned males over 50. Treatment options include topical application, electrosurgery, chemical peels, and laser vaporization.
Actinic cheilitis, also known as actinic cheilosis, is a precancerous lesion on the edges of the lip. It is often caused by chronic sun exposure and damage. The term actinic derives from the Greek word actis, which means ray, referring to the sun’s rays, while cheilitis means inflammation of the lip. Signs of actinic cheilitis include loss of the vermilion or red border of the lip, thickening, discoloration, and scale formation. It is more common in males over the age of 50 and in fair-skinned individuals who are chronically exposed to the sun.
The main cause of actinic cheilitis is exposure to ultraviolet rays from the sun for extended periods without protection. Ultraviolet rays damage cells and their DNA, leading to changes such as thickening of the superficial dermis, formation of blue-gray or elastose elastic fibers by sun-damaged fibroblasts, increased keratin production, and increased nucleus-to-cytoplasm ratio or atypia. The pathogenesis of actinic cheilitis is similar to that of actinic keratosis, which refers to a premalignant lesion on other sun-exposed sites such as the face, back of the hands, and arms. Both actinic cheilitis and actinic keratosis can cause squamous cell carcinoma.
Actinic cheilitis usually develops very slowly and the affected person does not initially notice the change. The first symptoms of actinic cheilitis that occur include mild swelling of the lip, loss of the vermillion border between the lip and the surrounding skin, and some areas with paleness and redness. As it gets worse, the area becomes rough, thickened, scaly, and dry. Acquired dyskeratotic leukoplakia, which manifests itself as white plaques on the lips, may also appear.
Some people develop painless ulcers in the affected area, particularly when it’s subjected to minor trauma. These ulcers can exist for months or years before the patient actually goes to the doctor. Ulcers lasting more than two months raise the suspicion of malignant degeneration and should be biopsied.
Actinic keilosis is irreversible and about 6-10% of cases eventually develop into squamous cell carcinoma, so doctors’ consensus is to treat it as soon as it is diagnosed. Confirmation of the diagnosis occurs through a skin biopsy. Treatment options for actinic cheilitis include topical application of 5-fluorouracil or imiquimod, electrosurgery, chemical peels, scalpel vermillionectomy or lip shaving, and carbon dioxide laser vaporization. These methods lead to the destruction or removal of the affected epithelium, but can cause pain and swelling after treatment. Fortunately, these treatment options are curative and have a low recurrence rate.
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