II. Epidemiology
- Prevalence 10 to 40% in high risk occupational exposures (e.g. fishermen, farmers)
III. Pathophysiology
- Premalignant lip lesion associated with chronic UV radiation exposure
- Lower lip more often affected
IV. Risk Factors
- Light skin tones
- Outdoor work >25 years
- Age >60 years old
- History of Nonmelanoma Skin Cancer
-
Genetic Syndromes with increased sun susceptibility (younger age at presentation)
- Xeroderma pigmentosum
- Oculocutaneous Albinism
V. Signs
- Early Changes
- Persistent dry, Scaling lips
- Sandpaper feel to involved lip
- Mild lip atrophy
- Later, More Advanced Changes
- Lip atrophy
- Vermillion border with blurred margin
- Localized Edema or erythema
- Hyperkeratotic Plaques
- Ulceration
- Crusting
VI. Labs: Biopsy Indications
- Avoid biopsy in early, mild to moderate typical Actinic Cheilitis
- Biopsy lesions suspicious for Squamous Cell Carcinoma
- Hyperkeratotic or Nodular areas of the lip with or without erosions or ulcerations
VII. Complications
- Lip Squamous Cell Carcinoma
- Higher Squamous Cell Carcinoma progression risk than with Actinic Keratosis
VIII. Management
- Refer if suspicion for lip Squamous Cell Carcinoma
- Topical Treatments used for Actinic Cheilitis or Squamous Cell Carcinoma In Situ