Diagnostic Considerations
Other considerations include the following:
-
Granulomatous conditions - Cheilitis granulomatosa, orofacial granulomatosis, Crohn disease, sarcoidosis
-
Lymphangioma and other vascular proliferations
-
Mucus extravasation or retention phenomena
-
Minor salivary gland neoplasms
-
Chronic actinic injury
-
Actinic cheilitis
-
Chronic sialadenitis
-
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
Differential Diagnoses
-
Candidiasis (angular cheilitis)
-
Premalignant Conditions of the Oral Cavity
-
Squamous cell carcinoma of lip
-
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).