Cases Of Actinic Cheilitis Research Articles

Two Cases of Actinic Cheilitis Clinically Mistaken for Candidal Infection

Two Cases of Actinic Cheilitis Clinically Mistaken for Candidal Infection

Cheilitis Glandularis of the Lower Lip

Cheilitis glandularis is an uncommon disease most commonly affecting the lower lip caused by hyperplasia of minor salivary glands with the presence of inflammatory component. UV rays have been considered the primary cause for CG. It has categorized into 3 clinical types: simple, superficial suppurative, and deep suppurative. [1]. The lack of sufficient data makes the diagnosis and treatment of the disease cumbersome. Hereby we report a case of actinic cheilitis of the lower lip and discuss its diagnostic and therapeutic aspects.

Histopathologic features in actinic cheilitis by the comparison of grading dysplasia systems

This study aimed to determine the histopathologic findings in actinic cheilitis (AC) and lip squamous cell carcinomas (LSCC) diagnosed at Federal University of Santa Catarina in order to attempt to predict the evolution from AC to LSCC based on the comparison of two dysplasia classification systems. Histopathologic features were evaluated according to the World Health Organization classification of dysplasia and binary system of classification. Also, in LSCC, pattern, stage of invasion, and degree of keratinization were evaluated. A total of 58 cases of AC and 70 cases of LSCC were studied, and data correlation was performed using statistical analysis. The presence of dyskeratosis and keratin pearls was found to be strongly associated with severe dysplasia and could represent higher proximity between the severe dysplasia in AC and LSCC. Also, changes related to the nuclei, such as hyperchromasia, nuclear pleomorphism, anisonucleosis, increase in the number and size of nucleoli, increased number of mitoses, and atypical mitoses, indicate progression in dysplasia spectrum. Knowledge of clinical and histological features of AC and LSCC leads to better understanding of factors possibly associated with malignant transformation of epithelial dysplasia.

Immunohistochemical expression of matrix metalloproteinase-1, matrix metalloproteinase-2 and matrix metalloproteinase-9, myofibroblasts and Ki-67 in actinic cheilitis and lip squamous cell carcinoma.

Matrix metalloproteinases (MMPs), myofibroblasts (MFs) and epithelial proliferation have key roles in neoplastic progression. In this study immunoexpression of MMP-1, MMP-2 and MMP-9, presence of MFs and the epithelial proliferation index were investigated in actinic cheilitis (AC), lip squamous cell carcinoma (LSCC) and mucocele (MUC). Thirty cases of AC, thirty cases of LSCC and twenty cases of MUC were selected for immunohistochemical investigation of the proteins MMP-1, MMP-2, MMP-9, α-smooth muscle actin (α-SMA) and Ki-67. The MMP-1 expression in the epithelial component was higher in the AC than the MUC and LSCC. In the connective tissue, the expression was higher in the LSCC. MMP-2 showed lower epithelial and stromal immunostaining in the LSCC when compared to the AC and MUC. The epithelial staining for MMP-9 was higher in the AC when compared to the LSCC. However, in the connective tissue, the expression was lower in the AC compared to other lesions. The cell proliferation rate was increased in proportion to the severity of dysplasia in the AC, while in the LSCC it was higher in well-differentiated lesions compared to moderately differentiated. There were no statistically significant differences in number of MFs present in the lesions studied. The results suggest that MMPs could affect the biological behaviour of ACs and LSCCs inasmuch as they could participate in the development and progression from premalignant lesions to malignant lesions.

Clinicopathological profile and management of 161 cases of actinic cheilitis.

BACKGROUNDActinic cheilitis (AC) is a potentially malignant disorder of the lip caused by chronic exposure to ultraviolet radiation from the sun.OBJECTIVESTo evaluate the clinical, demographic, morphological and therapeutic management in AC cases data associating to the histopathological grading.METHODSDemographic, clinical and management data of 161 patients with AC were analyzed. In biopsied cases, two calibrated examiners performed histopathological grading by binary system.RESULTSThere was a prevalence of males (79.5%), aged 40 years or older (77.5%), light-skinned (85.7%), experiencing occupational exposure to sunlight (80.3%), with AC presenting clinically as white lesions (33.6%). Conservative treatment was adopted in 78 cases and biopsy in 83 cases (60.2% graded as low-risk AC). There were no significant associations between histopathological grading and gender (p= 0.509), age (p=0.416), ethnicity (p=0.388), occupational exposure to sunlight (p=1.000) or clinical presentation (p=0.803).CONCLUSIONThis study reinforces the hypothesis that demographic and clinical characteristics of AC are not related to histopathological grading. Advice on protection from sun exposure should be encouraged to avoid progression of AC and invasive therapies.

Ki-67, TGF-β1, and elastin content are significantly altered in lip carcinogenesis.

Epithelial changes observed in actinic cheilitis (AC) and lower lip squamous cell carcinoma (LLSCC) have been studied using different markers in order to observe diagnostic and prognostic factors for both lesions. The aim of the present study was to analyze Ki-67, TGF-β1, and elastin content in AC and LLSCC to determine the possible role of these proteins in lip carcinogenesis. Medical records of 29 cases of AC and 53 cases of LLSCC were analyzed. Lesions were classified according histological pattern and submitted to immunostaining for Ki-67, TGF-β1, and elastin. Different percentages of Ki-67-positive cells were found in AC depending on the degree of epithelial dysplasia (p < 0.01). An association was also found between the percentage of Ki-67-positive cells and tumor grade in LLSCC (p < 0.01). An inverse correlation was found between Ki-67 and TGF-β1 in AC and LLSCC (p < 0.01). Elastosis was thinner and more discontinuous in LLSCC in comparison to AC, and this difference in the elastin immunolabeling pattern was statistically significant between groups (p < 0.01). The present findings indicate that changes in Ki-67 and TGF-β1 content contribute to lip carcinogenesis. Furthermore, elastin content reflects changes in the extracellular matrix in both AC and LLSCC.

Participation of HMLH1, MDM2, and P63 in Lower Lip Carcinogenesis

This study evaluated the epithelial expression of hMLH1, MDM2, and p63 in lower lip actinic cheilitis (AC) and lower lip squamous cell carcinoma (SCC) cases. Study Design: Forty cases of AC and 40 cases of SCC underwent immunoperoxidase method analysis. A thousand cells of each case were counted for immunohistochemical analysis. The data were analyzed quantitatively, and expression was compared by Mann-Whitney, Student t-test, or one-way ANOVA (p ≤ 0.05). Results: The hMLH1 expression was higher in cases of AC without dysplasia or with mild dysplasia (721.23 ± 88.116), whereas fewer positive cells were observed in lower lip SSCs (255.03 ± 199.47) when compared to the AC group (p < 0.001).

Elastofibromatous Lesion in The Oral Mucosa

Elastofibromas are tumor-like lesions composed of elastic and fibrous connective tissue and often associated with local trauma. Although solar elastosis is routinely seen in actinic cheilitis cases, intraoral trauma-induced elastosis, usually referred as elastofibromatous lesions, is rarely reported. Woman, 63, was referred for management of a lesion located in the right buccal mucosa that had been detected during routine oral examination. The patient reported no local trauma or prior surgery. Intraoral examination disclosed a whitish-translucent plaque.

Chloroquine: An Alternative Treatment Modality for Actinic Cheilitis

Modern times has seen an increase in number of people working in fields in the rural areas of the country, leading to an increase in sunlight-induced skin diseases in this group of the population. Actinic cheilitis is a potentially premalignant condition caused through exposure to sunlight, which involves the vermillion border of the lip and is readily diagnosed clinically. Early identification of the lesion can allow for the development of novel treatment strategies for patients to prevent the disease progression and its malignant transformation. The present article reports a case of actinic cheilitis in a middle-aged patient, who was treated with chloroquine and had shown a satisfactory treatment outcome.

Relationship between the epithelial expression of hMLH1, MDM2, and p63 and lower lip carcinogenesis

To evaluate the relationship between the epithelial expression of hMLH1, MDM2, and p63 in lower lip carcinogenesis, comparing the immunostaining of these proteins in cases of actinic cheilitis (AC) and lower lip squamous cell carcinoma (SCC). Forty cases of AC and 40 cases of SCC were studied, both lesions were of lower lip. Histological sections of 3μm were submitted to immunoperoxidase method, and 1000 cells were counted for immunohistochemical analysis of lesions. The results were analyzed quantitatively, and expression was compared by the Mann-Whitney, Student t-test, or one-way ANOVA, adopting a level of significance of 5%. A higher percentage of epithelial cells expressing hMLH1 was observed in cases of AC without dysplasia or mild dysplasia (721.23±88.116), whereas fewer positive cells were observed in lower lip SSCs (255.03±199.47) when compared to the AC group (P<0.001). Immunoexpression of MDM2 was higher in SCCs of the lower lip compared with AC (P=0.019). For p63 protein, the expression was higher in AC than in SCC (P=0.045). The present results showed changes in the immunoexpression of hMLH1, MDM2, and p63 in epithelial cells from premalignant and malignant lip disease, supporting the hypothesis that these alterations are related to the process of lower lip carcinogenesis.

Actinic cheilitis: clinicopathologic profile and association with degree of dysplasia

Actinic cheilitis (AC) is a potentially malignant disorder of the lip caused by exposure to solar radiation. This study was conducted to evaluate the clinicopathologic profile of cases of AC and to verify associations with the degree of dysplasia. This retrospective study analyzed data for 40 patients with AC. Demographic, clinical, and histopathologic data were evaluated. Sections measuring 5 μm in thickness were cut, deparaffinized, and stained with hematoxylin and eosin for histologic examination. The degree of epithelial dysplasia was graded using the criteria defined by the World Health Organization. Two calibrated oral pathologists analyzed the slides. Analysis of the AC patients sampled showed that 75.0% were male (P=0.002), 80.0% were aged≥40 years (P<0.001), 74.3% were Caucasian (P=0.004), and 68.6% had occupational exposure to sunlight (P=0.028). The most common clinical manifestation was white lesions (55.0%), and 40.0% of patients had no dysplasia. No significant associations emerged between the histologic grading of AC and gender (P=1.000), age (P=1.000), ethnicity (P=0.416), occupational exposure to sunlight (P=1.000), and clinical presentation (P=0.467). The degree of dysplasia in AC was not statistically associated with gender, age, ethnicity, occupational exposure to sunlight, or clinical appearance. This study provides some support for the hypothesis that clinicopathologic features are not related to the degree of dysplasia in AC.

Prevalencia de queilitis actínica en trabajadores expuestos a radiación ultravioleta en Talca, Chile

The objective of this research is to determine the prevalence of actinic cheilitis (AC) and associated factors in workers exposed to solar UV radiation in the city of Talca (Chile). A total of 151 workers, of which 16.6% exhibited AC, were examined. All lesions appeared on the lower lip. The 40% of cases aged between 50–59 years and 96% of patients diagnosed worked up to 6 hours daily exposed to the sun. 56% of the diagnoses of AC had a history of 20 or more years of exposure to UV radiation for work. 56% of cases of AC had a history of smoking. Major signs present in the AC cases were the dryness (100%), blurred demarcation between the lip vermilion border and the skin (88%) and labial edema (84%). Most lesions were asymptomatic (60%).

Immunohistochemical analysis of mismatch proteins in carcinogenesis of the lower lip

This study investigated the immunohistochemical expression of hMLH1 and hMSH2 proteins in lower lip squamous cell carcinoma (SCC) and actinic cheilitis (AC), to contribute to the understanding of the development of lower lip cancer. Forty cases of lower lip AC and SCC were studied. Quantitative immunohistochemical analysis was undertaken by counting 1000 cells (positive and negative) in each lesion. Statistical evaluation included Student's t-test and one-way ANOVA. For SCC and AC, the mean number of hMLH1- and hMSH2-positive cells decreased with advanced stage of the lesion. The largest mean number of immunostained cells was observed in AC cases without dysplasia or with mild dysplasia (hMLH1: 721.23 ± 88.116; hMHS2: 781.50 ± 156.93). Intermediate values were obtained for AC with moderate or severe dysplasia (hMLH1: 532.86 ± 197.72; hMHS2: 611.14 ± 172.48). Lower lip SSCs presented the smallest number of positive cells (hMLH1: 255.03 ± 199.47; hMHS2: 518.38 ± 265.68). A statistically significant difference was observed between groups (P < 0.001). The results support the hypothesis that changes in the immunoexpression of these mismatch proteins are related to the process of carcinogenesis of the lower lip.

Clinical and morphologic profile in a serie of cases of actinic cheilitis

Clinical and morphologic profile in a serie of cases of actinic cheilitis

A clinicopathologic descriptive study of 69 cases of actinic cheilitis using autofluorescence imaging systems as auxiliary diagnostic tools

A clinicopathologic descriptive study of 69 cases of actinic cheilitis using autofluorescence imaging systems as auxiliary diagnostic tools

Expression of laminin-5 and integrins in actinic cheilitis and superficially invasive squamous cell carcinomas of the lip

The progression of carcinogenesis entails the detachment of cells, invasion and migration of neoplastic cells. Alterations in epithelial adhesion and basement membrane proteins might mediate the early stages of carcinogenesis. This study investigated the expression of adhesion molecules and the basement membrane protein laminin-5 in actinic cheilitis (AC) and incipient squamous cell carcinoma of the lower lip to understand early photocarcinogenesis. Ln-5γ2 chain as well as α3, β1 subunits of α3β1 heterodimer and β4 subunit of integrin α6β4 were evaluated by immunohistochemistry in 16 cases of AC and 16 cases of superficially invasive squamous cell carcinoma (SISCC). Most AC cases showed reduced expression of β1, β4 and α3 integrins, and SISCCs lacked β1, β4 and α3 integrins in the invasive front. AC cases were negative for the Ln-5γ2 chain. Five cases of SISCC (31%) showed heterogeneous Ln-5γ2 chain expression in the invasive front of the tumor. Integrin β1, β4 and α3 expression is lost during the early stages of lip carcinogenesis. Expression of Ln-5γ2 in the invasive front in cases and its correlation with tumor progression suggest that it mediates the acquisition of the migrating and invading epithelial cell phenotype.

Mast cells and matrix metalloproteinase 9 expression in actinic cheilitis and lip squamous cell carcinoma

The aim of this study was to evaluate mast cell (MC) density and migration and their association with matrix metalloproteinase (MMP) 9 expression in squamous cell carcinoma (SCC) and actinic cheilitis (AC). Tryptase, c-Kit, and MMP-9 expression was evaluated in 20 cases of SCC, 20 cases of AC, and 7 cases of normal lip (control samples) by immunohistochemistry techniques. Tryptase(+) and c-Kit(+) MC densities were significantly higher in SCCs than in ACs and control samples (P < .001). However, no significant difference was found when comparing tryptase(+) and c-Kit(+) MC densities between ACs and control samples (P values .185 and .516, respectively). MMP-9 was strongly expressed in SCCs and moderately expressed in ACs and control samples. A highly significant association was found between tryptase(+) MC density and the expression of MMP-9 (P < .001). The increase in MC density associated with the strong expression of MMP-9 may favor SCC progression.

Non‐invasive diagnosis and monitoring of actinic cheilitis with reflectance confocal microscopy

Actinic cheilitis (AC) represents the equivalent of actinic keratosis on the lip. Various treatment modalities are available and the efficacy of diclofenac in hyaluronic acid has recently been described. Reflectance confocal microscopy (RCM) is a non-invasive imaging technique which has recently been applied for the diagnosis of actinic keratoses. Herein, we describe the applicability of RCM for the diagnosis of AC and for monitoring of treatment response of AC to diclofenac in hyaluronic acid. Ten Caucasian patients with clinical suspicion for AC were included in this study. To obtain a non-invasive diagnosis, RCM was performed at baseline, followed by biopsy and respective confocal-histopathological correlation. Six patients with a histological diagnosis of AC were treated with diclofenac in hyaluronic acid, whereby monitoring was performed by RCM. Reflectance confocal microscopy was able to correctly identify 6/7 cases of AC and 3/3 cases of benign lesions. The most important RCM criteria for diagnosis of AC were cellular atypia at the stratum spinosum and granulosum with atypical honeycomb pattern. One patient with AC was misclassified as inflammatory cheilitis by RCM as it showed marked inflammatory response and lacked clear signs of cellular atypia on RCM imaging. Following topical treatment with diclofenac gel, 5/6 patients (83%) showed a good treatment response with regression of dysplasia on consecutive RCM examination. Reflectance confocal microscopy is a promising tool for the non-invasive diagnosis and monitoring of actinic cheilitis. However, marked inflammation represents a potential diagnostic pitfall. In this regard, biopsy should be performed in doubtful cases.

Altered β-catenin expression related to cancer progression on actinic cheilitis and squamous cell carcinoma of the lip

β-Catenin is a bifunctional protein related to cell adhesion and gene transcription when activated by Wnt pathway. Altered expression of β-catenin was related to loss of differentiation, more aggressive phenotype, increase of tumor invasion, and poor prognosis in a number of different cancers. Actinic cheilitis is caused by excessive exposure to ultraviolet radiation and has a high potential to suffer malignant transformation into squamous cell carcinoma (SCC) of the lip, the most frequent oral malignancy. Studies of oral cancer have shown the correlation of β-catenin expression and oral SCC prognosis, and loss of membrane expression may be considered as a potential marker for early tumor recurrence. Thirty-five cases of actinic cheilitis and 12 cases of SCC of the lip were select and submitted to immunohistochemical staining using β-catenin antibody. β-Catenin was positive on the membrane for all cases. Eighty-five percent of actinic cheilitis cases showed cytoplasmatic staining, and 22% nuclear staining. Eighty-three percent of SCC was positive for β-catenin, and none of them had nuclear staining. Cytoplasmatic and nuclear staining of β-catenin on studied cases point to pathway alterations. Results demonstrated that β-catenin expression is altered on epithelial dysplasia, and it is related to degree of alterations.

Accumulation of CD1a-positive Langerhans cells and mast cells in actinic cheilitis

LCs and MCs are known to be directly influenced by UV radiation. This study investigated the presence of Langerhans cells (LCs) and mast cells (MCs) in actinic cheilitis (AC) exhibiting epithelial dysplasia (ED). Using immunohistochemistry for CD1a and mast cell tryptase, LCs and MCs density was assessed in 35 cases of AC with different degrees of ED. LCs were found in 32 cases of AC whereas MCs were found in all cases. There was an increase in LCs density irrespective of degree of ED when the cases were compared to normal lip mucosa (P=0.04343). No statistical difference in LCs density was observed regarding the different degrees of dysplasia (P>0.05). Significant difference in MCs density between mild and moderate dysplasia and normal lip mucosa was found (P<0.05). No significant correlation between LCs and MCs was seen (P=0.1258). Although no correlation could be established between LCs and MCs and the different degrees of ED; it is possible that the accumulation of LCs plays an immunostimulatory and protective role in the defense against progression of dysplasia. Further studies are necessary to determine the role of MCs in the development of AC.