A 69 year old male presented with asymptomatic, persistent crusting involving his
lower lip. His medical history was significant for Type 2 diabetes mellitus which is
diet-controlled, and obstructive sleep apnoea for which he uses CPAP. He is an ex-
smoker of 20 pack years who quit 20 years ago, and does not consume alcohol.
Before retirement, he worked as a brick layer. His intra-oral examination did not
reveal any significant findings.
Which of the following is the most likely diagnosis?
1. Oral lichen planus
2. Herpes simplex virus 2 (Cold sore)
3. Actinic cheilitis
5. Perioral dermatitis
Answer:
3. Actinic cheilitis
Actinic cheilitis (AC) is a potentially premalignant condition involving predominantly the vermilion of the lower lip. It is a common, slowly-developing lesion caused by chronic or excessive exposure to solar radiation, in particular toultraviolet B.Dental practitioners are ideally placed to identify at-risk patients, particularly in Australia, where this condition is prevalent. While AC does not predict progression to malignancy, a small number of patients manifest with squamous cell carcinoma of the lip (about 6% risk). Conversely, almost all lip carcinomas are associated with pre-existing actinic cheilitis.
AC is more prevalent in light-complexioned persons with a tendency to sunburn. Most patients are older than 50 years. Outdoor workers or sun worshippers are at particular risk.
Clinical signs may include lip dryness, atrophy, scaling or crusting, swelling, erythema, ulceration, loss of vermilion border, lip fissures, plaques, and/or tissue pallor. Treatment modalities include surgery such as vermilionectomy, cryotherapy, laser therapy, topical use of chemotherapeutic agents or anti-inflammatory agents, and photodynamic therapy. Sun protection counselling is important.
