Cheilitis Glandularis Workup
- Author: Ellen Eisenberg, DMD; Chief Editor: William D James, MD more...
To rule out systemic granulomatous diseases (eg, sarcoidosis, Crohn disease), perform ACE levels, erythrocyte sedimentation rate, and CBC count and differential.
Reflectance confocal microscopy (RCM) was recently described by Laurenco et al. This is a noninvasive imaging technique that allows for in vivo en face visualization of tissues with resolution that approaches that of conventional microscopy. With RCM, the entire lip can be examined nonsurgically, from surface to deeper stromal structures. According to the investigators who applied RCM to patients with clinical features consistent with cheilitis glandularis, correlating the clinical, digital RCM images, and histopathology improved diagnostic skills in the evaluation of clinical findings suggestive of cheilitis glandularis.
Microbial culture and sensitivity testing may be warranted. In cases with acute or chronic suppuration, bacterial culture and sensitivity testing is indicated for selection of appropriate antibiotic therapy.
Fungal culture or smear may be warranted. Chronic angular cheilitis or erosive surface changes may be indicative of chronic candidal infection. Confirmation is an indication for appropriate antifungal therapy.
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.
Labial minor salivary gland biopsy (ie, sampling 8-10 labial minor salivary glands obtained through an incision into the mucosa of the lower lip) should be performed if Sjögren syndrome is suspected.
The term cheilitis glandularis is a provisional clinically 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 an individual case.
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 presence of epithelial maturational disturbance indicates 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.
Note the images below.
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