Actinic cheilitis (actinic keratosis of lip, solar keratosis, solar cheilosis; from the Greek aktino = rays and cheili = lips) is common in sun-overexposed individuals, and is essentially a burn. This chapter discusses chronic actinic cheilitis (solar cheilosis) – a potentially malignant disorder (~ 6% risk of squamous carcinoma).
Ultraviolet light from the sun can damage the lips and skin, particularly the vermilion of the lower lip. Commonly seen in Caucasians in the tropics, less in people with coloured skins. Particularly at risk are people whose lifestyles include much time spent outdoors, especially farmers, sailors, fishermen, windsurfers, skiers, mountaineers, golfers, etc.
Other forms of radiation including arc-welding can occasionally cause similar damage. Actinic cheilitis rarely may be an early manifestation of a genetic susceptibility to light damage as in xeroderma pigmentosum or part of the syndrome of actinic prurigo. Immune defects (including immunosuppression in organ transplant recipients) also predispose to malignant transformation.
Actinic cheilitis is most common on the lower lip, with sparing of the oral commissures. In the early, acute stages, the lip may be red and oedematous, but after months or years (chronic cheilitis) may become dry and scaly and wrinkled with grey to white changes. Lesions may appear as a smooth or scaly, friable patch or can involve the entire lip later, becoming palpably thickened with small greyish white plaques (Fig. 26.1). Eventually, warty nodules may form, which may evolve into OSCC.
|In most cases||In some cases|
TREATMENT (see also Chs 4 and 5)
Prevention is advised, especially in high-risk individuals (patients with photosensitivity disorders, xeroderma pigmentosum, transplant recipients), and those whose exposure to UVB is high by wearing broad-brimmed hats, and using adequate UV-protective sunscreens and avoiding mid-day sun exposure.