INTRODUCTION

This chapter should be read along with Ch. 25.

INCIDENCE

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).

CLINICAL FEATURES

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.

DIAGNOSIS

A careful history and a biopsy are indicated (Table 26.1). Lupus erythematosus and lichen planus must also be considered in the differential diagnosis.

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.

Management of established solar cheilosis is required both to relieve sympto/>