The 2-mm, white, very slightly raised lesion on the vermilion of a 37-year-old man's lower lip had been present for 2 months. The lesion was asymptomatic. There was no history of injury or burn to the area.
The lesion was excised. Pathologic examination revealed hyperkeratosis,parakeratosis, irregular squamous hyperplasia, a prominent granular cell layer, and focal intraepithelial squamous atypia with a lichenoid infiltrate and mild solar elastosis. These findings are consistent with actinic cheilitis with a lichen planus-like component. No malignancy was present.
Actinic cheilitis is also known as solar keratosis, actinic keratosis and, in the past, leukoplakia of the lip. The condition is seen most frequently on the vermilion of the lower lip; it is believed to be a premalignant lesion that is induced by chronic sun exposure. Squamous cell carcinoma may develop within areas of actinic cheilitis; however, the exact incidence of malignant transformation
is unknown. Depending on the lesion's size, a biopsy or excision is performed for diagnosis. Imiquimod or 5-fluorouracil can be used for treatment. Sunblock applied to the lips may prevent lesion formation.
(Case and photograph courtesy of Dr Robert P. Blereau.)