II. Epidemiology

  1. Prevalence 10 to 40% in high risk occupational exposures (e.g. fishermen, farmers)

III. Pathophysiology

  1. Premalignant lip lesion associated with chronic UV radiation exposure
  2. Lower lip more often affected

IV. Risk Factors

  1. Light skin tones
  2. Outdoor work >25 years
  3. Age >60 years old
  4. History of Nonmelanoma Skin Cancer
  5. Genetic Syndromes with increased sun susceptibility (younger age at presentation)
    1. Xeroderma pigmentosum
    2. Oculocutaneous Albinism

V. Signs

  1. Early Changes
    1. Persistent dry, Scaling lips
    2. Sandpaper feel to involved lip
    3. Mild lip atrophy
  2. Later, More Advanced Changes
    1. Lip atrophy
    2. Vermillion border with blurred margin
    3. Localized Edema or erythema
    4. Hyperkeratotic Plaques
    5. Ulceration
    6. Crusting

VI. Labs: Biopsy Indications

  1. Avoid biopsy in early, mild to moderate typical Actinic Cheilitis
  2. Biopsy lesions suspicious for Squamous Cell Carcinoma
    1. Hyperkeratotic or Nodular areas of the lip with or without erosions or ulcerations

VII. Complications

VIII. Management

  1. Refer if suspicion for lip Squamous Cell Carcinoma
  2. Topical Treatments used for Actinic Cheilitis or Squamous Cell Carcinoma In Situ
    1. Fluorouracil
    2. Cryotherapy (Liquid Nitrogen)
    3. Curettage
    4. Dermabrasion
    5. Imiquimod

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