eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Cheilitis Granulomatosa (Miescher-Melkersson-Rosenthal Syndrome): Differential Diagnoses & Workup

Author: Crispian Scully, MD, PhD, DSc, FRCPath, MRCS, CBE, MDS, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE, FMedSci, FHEA, FUCL, DChD, DMed(HC),, Professor, Director of Special Projects, Eastman Dental Institute for Oral Health Care Sciences; Professor, Special Needs Dentistry, University College; Professor, Oral Medicine, Pathology and Microbiology, University of London
Contributor Information and Disclosures

Updated: Oct 5, 2009

Differential Diagnoses

Angioedema, Acquired
Lymphoma
Angioedema, Hereditary
Rhinosporidiosis
Crohn Disease
Sarcoidosis
Leprosy
Tuberculosis

Other Problems to Be Considered

Dental abscess or infection
Trauma
Orofacial granulomatosis

Workup

Laboratory Studies

  • Serum angiotensin-converting enzyme test may be performed to help exclude sarcoidosis.
  • Patch tests may be used to help exclude reactions to metals, food additives, or other oral antigens. Some cases may be associated with such sensitivities. If found, avoidance of the implicated allergen is recommended.

Imaging Studies

  • Gastrointestinal tract endoscopy, radiography, and biopsy may be used to help exclude Crohn disease.
  • Chest radiography or gallium or positron emission tomography (PET) scanning may be performed to help exclude sarcoidosis and tuberculosis.
  • Panorex dental films may be obtained to assess for the presence of a chronic dental abscess.

Procedures

  • A biopsy of the swollen lip or orofacial tissues is indicated but often only shows lymphoedema and perivascular lymphocytic infiltration during the early stages and may only later show granulomas.
  • A biopsy may help exclude Crohn disease, sarcoidosis, lymphoma, and other conditions in the differential diagnosis.

Histologic Findings

Histologic changes are not always conspicuous or specific in many cases of long duration; the infiltrate becomes denser and pleomorphic, and small focal granulomas are formed that are indistinguishable from Crohn disease or sarcoidosis. Small granulomas occur in the lymphatic walls in some cases. Similar changes may be present in cervical lymph nodes.

More on Cheilitis Granulomatosa (Miescher-Melkersson-Rosenthal Syndrome)

Overview: Cheilitis Granulomatosa (Miescher-Melkersson-Rosenthal Syndrome)
Differential Diagnoses & Workup: Cheilitis Granulomatosa (Miescher-Melkersson-Rosenthal Syndrome)
Treatment & Medication: Cheilitis Granulomatosa (Miescher-Melkersson-Rosenthal Syndrome)
Follow-up: Cheilitis Granulomatosa (Miescher-Melkersson-Rosenthal Syndrome)
Multimedia: Cheilitis Granulomatosa (Miescher-Melkersson-Rosenthal Syndrome)
References
Further Reading
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References

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Further Reading

National Institute of Neurological Disorders and Stroke -NINDS Melkersson-Rosenthal Syndrome Information Page

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Keywords

granulomatous cheilitis, Miescher-Melkersson-Rosenthal syndrome, orofacial granulomatosis, Miescher cheilitis, Melkersson-Rosenthal syndrome, Rossolimo-Melkersson-Rosenthal syndrome, swelling of the lip, Crohn disease, Crohn's disease

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Contributor Information and Disclosures

Author

Crispian Scully, MD, PhD, DSc, FRCPath, MRCS, CBE, MDS, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE, FMedSci, FHEA, FUCL, DChD, DMed(HC),, Professor, Director of Special Projects, Eastman Dental Institute for Oral Health Care Sciences; Professor, Special Needs Dentistry, University College; Professor, Oral Medicine, Pathology and Microbiology, University of London
Crispian Scully, MD, PhD, DSc, FRCPath, MRCS, CBE, MDS, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE, FMedSci, FHEA, FUCL, DChD, DMed(HC), is a member of the following medical societies: Academy of Medical Science, British Dental Association, British Society for Oral Medicine, International Association for Dental Research, and Royal Society of Medicine
Disclosure: Nothing to disclose.

Medical Editor

David P Fivenson, MD, Associate Director, St Joseph Mercy Hospital Dermatology Program, Ann Arbor, Michigan
David P Fivenson, MD is a member of the following medical societies: American Academy of Dermatology, Medical Dermatology Society, Michigan Dermatological Society, Michigan State Medical Society, Photomedicine Society, Society for Investigative Dermatology, and Wound Healing Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Warren R Heymann, MD, Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey
Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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