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Author: Dr Mark Duffill, Dermatologist, Hamilton, New Zealand, 2008. Updated by Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, December 2015.
Actinic cheilitis is the lip form of actinic keratosis due to chronic sun exposure. It is also called actinic cheilosis, solar cheilitis, and sometimes, actinic cheilitis with histological atypia.
Actinic cheilitis mainly affects adults with fair skin who live in tropical or subtropical areas, especially outdoor workers. They often recall having sunburned lips in earlier years. They may also have actinic keratoses and/or solar lentigines on other sun-exposed sites of the scalp, ears, face, and hands.
Actinic cheilitis is three times more common in males than in females.
Actinic cheilitis results from chronic exposure of the lower lip to solar ultraviolet radiation. It is more vulnerable than surrounding skin because mucosal epithelium is thinner and less pigmented than the epidermis.
Actinic cheilitis most commonly affects the lower lip (90%), presenting as:
Other clinical features of actinic cheilitis may include:
Actinic cheilitis is a pre-malignant condition. It predisposes to:
Invasive squamous cell carcinoma should be suspected if the lip is focally tender, or a persistent ulcer or enlarging nodule develops.
The histological features of actinic cheilitis are variable thickening or atrophy of the lip, partial thickness epidermal dysplasia, solar elastosis, and inflammation in the dermis.
Smoking cessation and lifelong, year-round, daily sun protection are essential.
Men can consider growing a moustache.
Topical therapies for actinic cheilitis are unapproved. They include:
Physical treatments for actinic cheilitis include:
Vermilionectomy and carbon dioxide laser treatment have the most favourable outcome, with fewer recurrences compared to chemical peel and photodynamic therapy.
Actinic cheilitis can be prevented by protecting the lips from sun exposure. In smokers, the risk of cancer can be reduced by smoking cessation.
Actinic cheilitis can improve with effective sun protection and treatment. Continued sun exposure and lack of treatment increase the risk of squamous cell carcinoma, which is potentially life threatening.
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