Why haven’t emollients healed this lip fissure?

September 8, 2009

Despite frequent application of lip balm, this split on a 46-year-old woman’s lower lip has failed to heal. What do you suspect?

Case 2:
Despite frequent application of lip balm, this split on a 46-year-old woman’s lower lip has failed to heal.

What do you suspect?

A. Atopic dermatitis.
B. Lichen planus.
C. Leukoplakia.
D. Actinic cheilitis.
E. Contact dermatitis.

(Answer on next page)

This patient had actinic cheilitis, D. Squamous cell carcinoma of the lip typically arises on the vermilion border of the lower lip, close to the midline. The precursor lesion is actinic cheilitis, which manifests as xerosis, fissuring, atrophy, and dyspigmentation; it is analogous to actinic keratosis of the skin.


Lips affected by atopic dermatitis are usually red around the vermilion border, and the patient complains of dryness. Contact dermatitis also occurs around the vermilion border and is characterized by erythema and scale. Leukoplakia appears as a white area on the mucosal surface of the lip, and lichen planus produces a lacy appearance on the mucosal surface inside the lip.