Diagnostic Considerations

Other considerations include the following:

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
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)
Cheilitis Granulomatosa
Hyperhidrosis
Premalignant Conditions of the Oral Cavity
Squamous cell carcinoma of lip

Workup

Neville BW, Damm DD, Allen CA, Bouquot JE. Salivary Gland Pathology. Neville BW, Damm DD, Allen CA, Bouquot JE, eds. Oral and Maxillofacial Pathology. 3rd ed. St Louis, Mo: Saunders Elsevier; 2009. 462-3.
von Volkman R. Einege Falle von Cheilitis Glandularis Apostematosa (Myxadenitis Labialis). Virchows Arch Pathol Anat [A]. 1870. 50:142-4.
Sutton RL. Cheilitis glandularis apostematosa (with case report). J Cutan Dis. 1909. 27:151-4.
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.
Swerlick RA, Cooper PH. Cheilitis glandularis: a re-evaluation. J Am Acad Dermatol. 1984 Mar. 10(3):466-72. [Medline].
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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].
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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].
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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].
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].
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Media Gallery

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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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 Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

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, Dermatology of Southwest Ohio

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: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

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.

Cheilitis Glandularis Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

Tables

Contributor Information and Disclosures

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