Photoclinic: Actinic Cheilitis

A 68-year-old white man complained of a painful “raw” lip that had gradually developed over several years. Multiple, discrete, small erosions were noted on the lower lip, some of which were covered with an adherent yellow scale/crust. Removal of the scale/crust led to bleeding. None of the involved areas were indurated; regional lymph nodes were normal. Ted Rosen, MD, of Houston reports that a biopsy sample showed cytologic atypia of epidermal squamous cells, consistent with the clinical diagnosis of actinic cheilitis. This precursor to invasive squamous cell carcinoma is typically multifocal and may be asymptomatic. This condition is caused by long-term exposure to UV radiation in sunlight and typically affects those with fair skin. Uniformly effective treatment remains elusive. Options include repeated applications of trichloroacetic acid or imiquimod and liquid nitrogen cryosurgery. This patient responded to application of imiquimod 5% cream for 3 weeks.