Actinic Cheilitis

Key Points
Precancerous condition related to lifetime sun exposure
Most often affects the lower lip
Persistent dryness and cracking of the lips
More common in men, the elderly, and fair skinned persons
Strong association with tobacco use

Actinic cheilitis is a precancerous condition related to cumulative sun exposure, most often affecting the lower lip. Affected persons exhibit dryness and cracking of the lips, which is persistent, in addition to other symptoms of sun-damaged skin such as wrinkling and lesions. In 6-10% of cases, squamous cell carcinoma develops in affected persons.

Actinic cheilitis most commonly affects men, but also appears in the elderly and fair skinned persons. Tobacco use is also associated with its appearance. Located on the lips, most of the lower, symptoms include persistent redness, scaliness and chapping, occasionally accompanied by erosions and cracks in the tissue.

Differential Diagnosis (Other conditions with similar appearance)
Squamous cell carcinoma
Sun damage
Actinic keratosis

Diagnosis
Key Points
Diagnosis based on skin appearance
Skin biopsy may be performed to rule out malignancy

Actinic cheilitis is generally diagnosed based on appearance of the lips. Health care professionals may biopsy the affected area to determine if the condition is malignant.

Treatment
Prevention is the most important factor in combating the disorder
All occurrences should be treated, as the disorder has the potential to become malignant
Several treatments exist to destroy the affected tissue

Prevention of actinic cheilitis by wearing clothing such as wide brimmed hats to prevent sun exposure and the use of lip balms containing sunscreen is recommended.

Less extreme cases of actinic cheilitis can be treated in one of several ways, and generally do not recur once treated. The most common of these treatments is destruction of the damaged cells with cryosurgery. Alternatives include electrodessication of damaged cells and dermabrasion. Topical therapies with chemotherapeutic agents(5-fluorouracil) or topical immunomodulators(Imiquimod) may be ordered by health care professionals. Carbon dioxide laser resurfacing is also effective. In severe cases without evidence of malignancy, a lip shave procedure (vermilionectomy) may be used to treat the affected person.