Lower Lip Lesions in Fair-Skinned Patients: Time to Make Specific Diagnoses Other Than Actinic Cheilitis

Patients with light skin and chronic sun damage commonly develop lower lip lesions that are diagnosed as having actinic cheilitis. Unfortunately, there is no uniform definition for “actinic cheilitis” in the dermatologic or dental literature, impeding optimal patient treatment. Furthermore, unrelated, disparate cutaneous conditions have been labeled as “actinic cheilitis,” preventing comparisons between studies. We sought to reassess the diagnosis of patients who have been considered to have actinic cheilitis using only histopathologic diagnoses that are reproducible on other areas of the skin. To this end, we reanalyzed biopsies and vermilionectomy specimens that were obtained from 117 patients who were formerly diagnosed with actinic cheilitis in our hospital. A total of 117 biopsy specimens from 117 patients were reanalyzed. An additional 797 slides from vermilionectomy specimens that were acquired from several of these patients were examined. The following diagnoses were made: solar elastosis with normal or atrophic epithelium (603 slides from 83 patients); lichen simplex chronicus (105 slides from 30 patients); actinic keratosis/squamous cell carcinoma (85 slides from 50 patients); and lichen planus (4 slides from 4 patients). Actinic cheilitis is not a specific diagnosis; furthermore, such a diagnosis can be misleading in the treatment of patients. Specific dermatologic diagnoses should always be considered to improve patient treatment.