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Actinic Cheilitis / Actinic Keratosis of Lip / Solar Keratosis /
Solar Cheilosis
Actinic Cheilitis (Sailor’s lip; Solar Cheilitis, Actinic Keratosis of Lip, Solar Keratosis & Solar Cheilosis)

Definition

Actinic cheilitis is a chronic degenerative disorder of the lower lip (with sparing of the commissures).  This is a
type of
actinic keratosis which classically occurs on the lower lip and is directly related to long-term sun exposure.


Ætiology

Long-term exposure to sunlight.


Clinical Features

In the early stage, mild erythema (reddening) and œdema (swelling) followed by dryness and fine scaling of the
lower lip
vermilion border (the junction between the lip and skin) are the presenting signs.

As the lesion progresses, the
epithelium (skin) becomes thin and smooth, with small whitish-gray areas
intermingled with red regions and scaly formations.  
Erosions (ulcers) and tiny nodules may develop.

The
vermilion appears atrophic (thinned) and pale with a glossy surface and loss of demarcation at the vermilion
border
.  With progression, fissuring and ulceration can occur along with crusting or scaling.  Epithelial atrophy
and
elastosis are seen histologically and these changes are irreversible.  Areas of persistent ulceration should be
biopsied due to a 6 – 10% rate of
malignant transformation.

The lesion is
pre-malignant and usually occurs in fair-skinned men over 50 years of age, 4 – 8th decade of life
and who have had outdoor jobs / activities.


Laboratory Tests

Histo-pathological examination.


Differential Diagnosis

The following conditions should be considered before making a diagnosis of actinic cheilitis:

Websites & Articles:

New Zealand Dermatological Society (DermNZ)

Wikipedia

Bond's Book of Oral Diseases, 4th Edition

Australian Dental Journal

American Academy of Oral Medicine

ScienceDirect

Patient.Info


J Canadian Dent Assn 2007.  Clinical Practice.  Exfoliative Cheilitis - Report of a Case

BJOMS 2010.  Treatment of actinic cheilitis with imiquimod 5% & a retractor on the lower lip - clinical &
histological outcomes in 5 patients

Eur J Dent 2011.  Actinic Cheilitis.  A Case Report & a Review of the Literature

Int J Clin Med 2014.  Actinic Cheilitis - Clinical Characteristics Observed in 75 Patients and a Summary of the
Literature of This Often Neglected Premalignant Disorder

World J Clin Cases 2014.  Precancerous Lesions of Oral Mucosa

J Cutan Med & Surgery 2015.  Non-Melanoma Skin Cancer in Canada.  Chapter 3.  Management of Actinic
Keratoses

J Ind Acad Oral Med Radiol 2015.  Actinic Cheilitis.  A Review

British Association of Dermatologists 2016.  Actinic Keratosis

Int J Health Sci & Res 2019.  Actinic Cheilitis.  A Case Report with Review of Literature

Maxillofac Plast & Recon Surg 2019.  Proper Management of Suspicious Actinic Cheilitis
Last Updated 28th December 2019
Treatment

Protection of lips from sunlight.  Vermilionectomy in severe cases.  Treatment of malignancy is primarily surgical;
however, a trial of
topical chemotherapy with 5-fluorouracil can be used with early lesions.

Prophylactic
laser ablation or vermillionectomy may be performed in cases where malignant transformation has
not yet occurred.

Close long-term follow-up is indicated, as these patients are at risk for additional cancers associated with solar
damage.