This finely papular, slightly raised lesion below the vermilion border of a 53-year-old man’s lip had been present for several months; it was asymptomatic. Six years earlier, the patient had a squamous cell carcinoma of the left lower leg excised. He worked outdoors on an offshore oil rig.
Actinic cheilitis, or actinic keratosis of the lower lip, is caused by long-term exposure to UV radiation in sunlight.1 The gross features (eg, fissuring, scaling, and ulceration) and microscopic findings are identical for both actinic keratosis and squamous cell carcinoma. The metastasis rate of squamous cell carcinoma of the lip is about 11%,2 which is higher than that of squamous cell carcinoma at any other site.
Treatment options include cryotherapy, surgical excision, topical 5-fluorouracil, imiquimod, and diclofenac. This patient had moderate erythema around the incision site, which resolved several weeks after suture removal.
1. Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 4th
ed. Philadelphia: Mosby; 2004:736-743.
2. Moy RL. Clinical presentation of actinic keratoses and squamous cell carcinoma.
J Am Acad Dermatol. 2000;42(1, pt 2):8-10.