History
Cheilitis glandularis is a chronic progressive condition. Patients typically present for diagnostic consultation within 3-12 months of onset. Complaints vary according to the nature and the degree of pain, the enlargement and the loss of elasticity of the lip, and the extent of evident surface change.
Asymptomatic lip swelling initially occurs with clear viscous secretion expressible from dilated ductal openings on the mucosal surface.
Some patients report periods of relative quiescence interrupted by transient or persistent painful episodes associated with suppurative discharge.
A burning discomfort or a sensation of rawness referable to the vermilion border may be reported. This is associated with atrophy, speckled leukoplakic change, erosion, or frank ulceration with crusting.
Physical Examination
Cheilitis glandularis affects the lower lip almost exclusively, although it has been reported to affect the upper lip. [18, 16] It manifests as progressive, often multinodular enlargement, eversion, and induration.
Salivary gland duct orifices may be dilated and appear as red or black puncta.
Viscous clear secretions may initially exit the duct openings spontaneously.
In more suppurative cases, application of gentle pressure can elicit mucopurulent exudates. [19]
With advancing lip prominence and mucosal eversion, the mucosal-vermilion junction is obfuscated.
Prolonged exposure to the external environment results in desiccation and disruption of the labial mucous membrane, predisposing it to inflammatory, infectious, and actinic influences.
Cheilitis glandularis had historically been subclassified into three types, now believed to represent evolving stages in severity of a single progressive disorder. In the simple type, multiple, painless, papular surface lesions with central depressions and dilated canals are seen. The superficial suppurative type (also referred to as Baelz disease) consists of painless, indurated swelling of the lip with shallow ulceration and crusting. Cheilitis glandularis of the deep suppurative type (cheilitis glandularis apostematosa, cheilitis glandularis suppurativa profunda, myxadenitis labialis) comprises a deep-seated infection with formation of abscesses, sinus tracts and fistulas, mucoid/purulent discharge, [19] and potential for scarring.
The latter two types of cheilitis glandularis have the highest association with dysplasia and carcinoma, respectively.
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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.
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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).
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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).
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Note the fullness of the lower portion of the lip and the indistinct junction between the vermilion border and the skin.
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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).
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High-power photomicrograph of the minor salivary glands. Note ductal ectasia, acinar atrophy, interstitial fibrosis, and inflammation (hematoxylin and eosin, original magnification X100).
