Abstract

Actinic cheilitis or solar cheilosis is considered a precursor of malignancy or even an in situ squamous cell carcinoma (SCC) of the lip, located most frequently on the lower lip. Actinic cheilitis (AC) has a higher likelihood of developing into invasive SCC of the lip, which is one of the deadliest non-melanoma skin cancers. Risk factors include chronic UV exposure, increasing age, male gender, fair phototypes, chronic scarring, immunosuppressive therapy, and tobacco use. From a clinical point of view, AC is characterized by dryness, scaling, atrophy, indistinct borders, and erosions. Ulceration and the appearance of a nodule often suggest the progression to invasive SCC. Dermoscopic examination reveals white structureless areas, scales, erosions, and white halos of the vermilion. Reflectance confocal microscopy shows disruption of the stratum corneum, parakeratosis, an atypical honeycomb pattern, solar elastosis, and dilated and tortuous blood vessels with increased blood flow. The rate of malignant transformation ranges from 10 to 30% and early diagnoses and treatment are essential in preventing the development of invasive SCC. Optimal treatment has not been established yet, but invasive and topical treatments can be tried. The present paper aims to review the existing data regarding epidemiology, risk factors, clinical picture, non-invasive imaging, diagnosis, and therapy in AC.

Highlights

  • Squamous cell carcinoma of the lower lip is a highly aggressive non-melanoma skin cancer, which composes almost 1/3 of all oral cancers

  • Squamous cell carcinoma (SCC) of the lower lip begins as a precursor, actinic cheilitis (AC), or solar cheilosis (SC) (1)

  • In a study about Reflectance confocal microscopy (RCM) diagnostic criteria for Actinic cheilitis (AC) and squamous cell carcinoma (SCC), Lupu et al showed that the atypical honeycomb pattern and the presence of the targetoid cells in the epidermis were strongly associated with AC

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Summary

Frontiers in Medicine

Cheilitis — From Risk Factors to Therapy. Actinic cheilitis or solar cheilosis is considered a precursor of malignancy or even an in situ squamous cell carcinoma (SCC) of the lip, located most frequently on the lower lip. Actinic cheilitis (AC) has a higher likelihood of developing into invasive SCC of the lip, which is one of the deadliest non-melanoma skin cancers. Risk factors include chronic UV exposure, increasing age, male gender, fair phototypes, chronic scarring, immunosuppressive therapy, and tobacco use. The rate of malignant transformation ranges from 10 to 30% and early diagnoses and treatment are essential in preventing the development of invasive SCC. The present paper aims to review the existing data regarding epidemiology, risk factors, clinical picture, non-invasive imaging, diagnosis, and therapy in AC

INTRODUCTION
RISK FACTORS
CLINICAL PICTURE
Reflectance Confocal Microscopy
Malignant Transformation of AC
SURGICAL TREATMENTS
Conservative Modalities
Findings
CONCLUSIONS

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