eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Cheilitis Glandularis: Differential Diagnoses & Workup

Author: Ellen Eisenberg, DMD, Professor, Section Chair and Director, Oral and Maxillofacial Pathology, Oral Pathology Biopsy Service, Department of Oral Health and Diagnostic Sciences; Associate Professor, Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, University of Connecticut Health Center
Contributor Information and Disclosures

Updated: Dec 31, 2008

Differential Diagnoses

Candidiasis (angular cheilitis)
Cheilitis Granulomatosa (Miescher-Melkersson-Rosenthal Syndrome)
Hyperhidrosis
Premalignant Conditions of the Oral Cavity
Squamous cell carcinoma of lip

Other Problems to Be Considered

  • Granulomatous conditions - Cheilitis granulomatosa, orofacial granulomatosis, Crohn disease, sarcoidosis
  • Angioedema
  • Lymphangioma and other vascular proliferations
  • Mucus extravasation or retention phenomena
  • Minor salivary gland neoplasms
  • Chronic actinic injury
  • Actinic cheilitis
  • Bacterial infection - Elephantiasis nostras (after repeated streptococcal lymphangitis) of the lips
  • Atopic (eczematous) cheilitis
  • Chronic factitial injury (eg, habitual licking [ie, excessive moisture], biting, chewing, or sucking on the lip), excessive drying (from mouth breathing, exposure to wind, medication-induced xerostomia, or salivary dysfunction from autoimmunity, eg, Sjögren syndrome or HIV-infection)
  • Tobacco irritation or carcinogenic influence

Workup

Laboratory Studies

  • To rule out systemic granulomatous diseases (eg, sarcoidosis, Crohn disease) - ACE levels, erythrocyte sedimentation rate, CBC count and differential

Other Tests

  • Microbial culture and sensitivity testing: In cases with acute or chronic suppuration, bacterial culture and sensitivity testing is indicated for selection of appropriate antibiotic therapy.
  • Fungal culture or smear: Chronic angular cheilitis or erosive surface changes may be indicative of chronic candidal infection. Confirmation is an indication for appropriate antifungal therapy.

Procedures

  • Lip biopsy is indicated to rule out specific granulomatous diseases that predispose to lip enlargement and to aid in establishing a definitive diagnosis. A representative incisional biopsy specimen should consist of a wedge (or punch) of lip tissue that includes surface epithelium and is of adequate depth to ensure inclusion of several submucosal salivary glands.

Histologic Findings

The term cheilitis glandularis is a provisional descriptive designation rather than a definitive diagnosis. It refers to a constellation of clinical findings that can reflect a broad scope of possible histologic changes; therefore, no consistent or pathognomonic features of this disorder are seen at the microscopic level. Instead, a diverse array of possible alterations can be seen in both the surface epithelium and the submucosal tissues. These findings best enable the clinician to presumptively determine the etiology and the nature of individual cases.

The maturational profile of the epithelium can be essentially normal or show evidence of disturbance that ranges from varying degrees of atypia or dysplasia to frank carcinoma. Epithelial alterations attended by basophilic collagen degeneration (solar elastosis) constitute a diagnosis of actinic cheilitis. The severity of epithelial maturational disturbance tends to correspond with the degree of risk for progression to carcinoma.

The minor salivary glands may appear normal under the microscope, or they may exhibit various changes indicative of nonspecific sialadenitis. These changes can include atrophy or distention of acini, ductal ectasia with or without squamous metaplasia, chronic inflammatory infiltration and replacement of glandular parenchyma, and interstitial fibrosis. Suppuration and sinus tracts may be present in cases that involve bacterial infection.

Other possible histologic findings include stromal edema, hyperemia, surface hyperkeratosis, erosion, or ulceration.

More on Cheilitis Glandularis

Overview: Cheilitis Glandularis
Differential Diagnoses & Workup: Cheilitis Glandularis
Treatment & Medication: Cheilitis Glandularis
Follow-up: Cheilitis Glandularis
Multimedia: Cheilitis Glandularis
References
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References

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Further Reading

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Keywords

cheilitis glandularis, CG, suppurative sialadenitis, suppurative stomatitis glandularis, actinic cheilitis, squamous cell carcinoma, myxadenitis labialis, cheilitis apostematosa, Baelz disease, Baelz's disease

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Contributor Information and Disclosures

Author

Ellen Eisenberg, DMD, Professor, Section Chair and Director, Oral and Maxillofacial Pathology, Oral Pathology Biopsy Service, Department of Oral Health and Diagnostic Sciences; Associate Professor, Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, University of Connecticut Health Center
Ellen Eisenberg, DMD is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology
Disclosure: Nothing to disclose.

Medical Editor

Mark W Cobb, MD, Consulting Staff, WNC Dermatological Associates
Mark W Cobb, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and American Society of Dermatopathology
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Drore Eisen, MD, DDS, Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati
Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
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