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Cheilitis Glandularis Follow-up

  • Author: Ellen Eisenberg, DMD; Chief Editor: William D James, MD  more...
 
Updated: Feb 22, 2016
 

Further Outpatient Care

Monitor patients with documented actinic cheilitis with clinical observation once or twice a year for an indefinite period. This is because, in some cases, cheilitis glandularis has the potential for the development of lip carcinoma. Also, some patients with cheilitis glandularis may be at risk for the development of suppurative episodes if trauma to the lip surface is continuous. This can result in chronic ulceration or erosion, leading to portals of entry for bacterial invasion and inflammatory sequelae.

Clinical evidence of disease progression mandates biopsy and an appropriate treatment plan (topical chemotherapy with 5-fluorouracil or vermilionectomy, or in cases of squamous cell carcinoma, lip wedge resection).

Decisions concerning the advisability and timing of surgical cheiloplasty or vermilionectomy can be challenging in patients who exhibit clinical evidence of persistent habitual or deliberate factitial injury. Undertaking surgery is ill advised if the source of irritation or trauma is perpetuated. Patients who are highly symptomatic and/or functionally compromised by lip enlargement and its complications should be offered the option of surgical debulking, regardless of the cause. Whether or not the surgical approach is ultimately successful depends on factors unique to the patient.

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Deterrence/Prevention

Where relevant, patients who habitually lick their lips should be advised to avoid this behavior.

Sun-protective measures (eg, wearing a hat with a visor, lip balm with sun-blocking agents, avoidance of direct and protracted sun exposure) must also be instituted.

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Prognosis

Cheilitis glandularis has been associated with a heightened risk for the development of squamous cell carcinoma. In many cases, dysplastic (premalignant) surface epithelial change is evident histopathologically, and frank carcinomas have been reported in 18-35% of cases. Rarely, cases of chronic persistent or recurrent suppurative infection may result from inappropriate antibiotic treatment.

A case of persistent suppurative cheilitis glandularis, confirmed by punch biopsy, in a 52-year-old African American woman with a 15-pack year smoking history responded to a 4-week course of oral penicillin at 1 g/d combined with oral fluoroquinolone at 1 g/d. Two weeks into the therapy, the swelling was significantly reduced. The antibiotic regimen was continued for 2 additional weeks, with resolution of the lip lesions and continued normality at 1-year follow-up.[23]

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Patient Education

Reinforce instruction in measures for sun protection.

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Contributor Information and Disclosures
Author

Ellen Eisenberg, DMD Professor and Section Chair, Section of Oral and Maxillofacial Pathology, Division of Oral and Maxillofacial Diagnostic Sciences, Department of Oral Health and Diagnostic Sciences, University of Connecticut School of Dental Medicine; Associate Professor, Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, University of Connecticut School of Medicine, University of Connecticut Health Center

Ellen Eisenberg, DMD is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Association of University Professors, American Dental Education Association, Connecticut Society of Oral and Maxillofacial Surgeons, Connecticut Society of Pathologists, Eastern Society of Teachers of Oral Pathology, International Academy of Oral and Maxillofacial Pathology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

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, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

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, American Society of Dermatopathology

Disclosure: Nothing to disclose.

References
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  2. von Volkman R. Einege Falle von Cheilitis Glandularis Apostematosa (Myxadenitis Labialis). Virchows Arch Pathol Anat [A]. 1870. 50:142-4.

  3. Sutton RL. Cheilitis glandularis apostematosa (with case report). J Cutan Dis. 1909. 27:151-4.

  4. Sutton RL. The symptomatology and treatment of three common diseases of the vermilion border of the lip. Int Clin (series 24). 1914. 3:123-8.

  5. Swerlick RA, Cooper PH. Cheilitis glandularis: a re-evaluation. J Am Acad Dermatol. 1984 Mar. 10(3):466-72. [Medline].

  6. Stoopler ET, Carrasco L, Stanton DC, Pringle G, Sollecito TP. Cheilitis glandularis: an unusual histopathologic presentation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Mar. 95(3):312-7. [Medline].

  7. Musa NJ, Suresh L, Hatton M, Tapia JL, Aguirre A, Radfar L. Multiple suppurative cystic lesions of the lips and buccal mucosa: a case of suppurative stomatitis glandularis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 Feb. 99(2):175-9. [Medline].

  8. Reichart PA, Scheifele Ch, Philipsen HP. [Glandular cheilitis. 2 case reports]. Mund Kiefer Gesichtschir. 2002 Jul. 6(4):266-70. [Medline].

  9. Leao JC, Ferreira AM, Martins S, et al. Cheilitis glandularis: An unusual presentation in a patient with HIV infection. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Feb. 95(2):142-4. [Medline].

  10. Butt FM, Chindia ML, Rana FS, Ashani A. Cheilitis glandularis progressing to squamous cell carcinoma in an hiv-infected patient: case report. East Afr Med J. 2007 Dec. 84(12):595-8. [Medline].

  11. Carrington PR, Horn TD. Cheilitis glandularis: a clinical marker for both malignancy and/or severe inflammatory disease of the oral cavity. J Am Acad Dermatol. 2006 Feb. 54(2):336-7. [Medline].

  12. Parmar RC, Muranjan MN. A newly recognized syndrome with double upper and lower lip, hypertelorism, eyelid ptosis, blepharophimosis, and third finger clinodactyly. Am J Med Genet A. 2004 Jan 15. 124A(2):200-1. [Medline].

  13. Cohen DM, Green JG, Diekmann SL. Concurrent anomalies: cheilitis glandularis and double lip. Report of a case. Oral Surg Oral Med Oral Pathol. 1988 Sep. 66(3):397-9. [Medline].

  14. Dhanapal R, Nalin Kumar S, Saraswathi TR, et al. Maxillary double lip and cheilitis glandularis: An unusual occurence. J Oral Maxillofac Pathol. 2007. 11:35-7. [Full Text].

  15. Nico MM, Nakano de Melo J, Lourenço SV. Cheilitis glandularis: a clinicopathological study in 22 patients. J Am Acad Dermatol. 2010 Feb. 62(2):233-8. [Medline].

  16. Winchester L, Scully C, Prime SS, Eveson JW. Cheilitis glandularis: a case affecting the upper lip. Oral Surg Oral Med Oral Pathol. 1986 Dec. 62(6):654-6. [Medline].

  17. Lourenço SV, Kos E, Borguezan Nunes T, Bologna SB, Sangueza M, Nico MM. In vivo reflectance confocal microscopy evaluation of cheilitis glandularis: a report of 5 cases. Am J Dermatopathol. 2015 Mar. 37 (3):197-202. [Medline].

  18. Bovenschen HJ. Novel treatment for cheilitis glandularis. Acta Derm Venereol. 2009. 89(1):99-100. [Medline].

  19. Erkek E, Sahin S, Kilic R, Erdogan S. A case of cheilitis glandularis superimposed on oral lichen planus: successful palliative treatment with topical tacrolimus and pimecrolimus. J Eur Acad Dermatol Venereol. 2007 Aug. 21(7):999-1000. [Medline].

  20. Lourenço SV, Gori LM, Boggio P, Nico MM. Cheilitis glandularis in albinos: a report of two cases and review of histopathological findings after therapeutic vermilionectomy. J Eur Acad Dermatol Venereol. 2007 Oct. 21(9):1265-7. [Medline].

  21. Aydin E, Gokoglu O, Ozcurumez G, Aydin H. Factitious cheilitis: a case report. J Med Case Reports. 2008 Jan 29. 2:29. [Medline].

  22. Michalowski R. Munchausen's syndrome: a new variety of bleeding type-self-inflicted cheilorrhagia and cheilitis glandularis. Dermatologica. 1985. 170(2):93-7. [Medline].

  23. Bender MM, Rubenstein M, Rosen T. Cheilitis glandularis in an African-American woman: response to antibiotic therapy. Skinmed. 2005 Nov-Dec. 4(6):391-2. [Medline].

 
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A 56-year-old woman with an 18-month history of chronic swelling and a dry, burning sensation in her lower lip. She reports intermittent increases and decreases in size of the lip with painful episodes of erosion, crusting, and rare instances of drainage. History reveals medication-induced xerostomia plus a tendency to compulsively lick the lip to maintain hydration. Note eversion of the mucosal surface, which appears erythematous and dry, and narrowing of the vermilion border. The lower labial mucosa appears nodular; however, on palpation, it is diffusely soft. The composite features are consistent with a clinical impression of cheilitis glandularis. A lip biopsy sample was obtained.
Medium-power photomicrograph. Note mildly atypical epithelial maturation, modest lymphocytic infiltrate within the lamina propria region, and the striking basophilic collagen degeneration within the superficial stroma plus telangiectasias. The composite features are consistent with a diagnosis of actinic cheilitis (hematoxylin and eosin, original magnification, X100).
Low-power photomicrograph. Deep submucosa of the lip. Several minor salivary glands demonstrate ductal ectasia, interstitial inflammation, atrophy, and fibrosis. No evidence of salivary gland hypertrophy is seen (hematoxylin and eosin, original magnification X40).
Note the fullness of the lower portion of the lip and the indistinct junction between the vermilion border and the skin.
Lip biopsy specimen. Low-power photomicrograph reveals focal surface hyperkeratosis accompanied by vascular congestion and fibrosis of the underlying stroma (hematoxylin and eosin, original magnification X40).
High-power photomicrograph of the minor salivary glands. Note ductal ectasia, acinar atrophy, interstitial fibrosis, and inflammation (hematoxylin and eosin, original magnification X100).
 
 
 
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