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Objective: Actinic cheilitis (AC) is a chronic lesion that usually precedes the onset of squamous cell carcinoma of the lip. Microscopically, AC may exhibit epithelial dysplasia (ED). Twist is a transcription factor that regulates the mesenchymal phenotype through negative E‐cadherin regulation. This study evaluated Twist and E‐cadherin immunoexpression in AC with different ED degrees. Materials and Methods: Twist and E‐cadherin immunoexpression was evaluated semiquantitatively in the epithelium of 86 cases of AC with different ED degrees. Data obtained were submitted to the Mann–Whitney test and Spearman's correlation test. Results: Immunohistochemical analysis revealed nuclear and cytoplasmic Twist immunoreactivity in all epithelial layers except the cornified layer. In contrast, the membrane and cytoplasmic E‐cadherin immunoreactivity was observed in all epithelial layers except the cornified layer. No significance was observed between the scores of these proteins and the ED degree. It was observed a correlation between total Twist and total (p = 0.030) and membrane (p = 0.014) E‐cadherin and between nuclear Twist and cytoplasmic E‐cadherin (p = 0.030). Conclusions: The results suggest that the high immunoexpression of Twist is an early lip carcinogenesis event. However, it appears not to influence the progression of ED in AC. [ABSTRACT FROM AUTHOR]

The study aimed to present the characteristics of the three most prevalent oral potentially malignant disorders, leukoplakia, oral lichen planus (OLP), and actinic cheilitis, using data from 62 patients collected at the “Sfântul Spiridon” Emergency Clinical Hospital in Iași, Romania, between January 2015 and January 2023. The results revealed a higher prevalence of these lesions among older adults, particularly those over 50 years old, and a significant gender disparity in the incidence of actinic cheilitis, which was more common in males (68%). Leukoplakia was frequently observed on the tongue and lower lip, whereas OLP commonly affected the buccal mucosa. Actinic cheilitis was primarily noted on the lower lip, attributed to chronic sun exposure. The study highlighted the importance of early detection and regular monitoring of these conditions to prevent malignant transformation.

Background: To evaluate the presence of myofibroblasts (MFs) in the development of lip carcinogenesis, through the correlation of clinical, histomorphometric and immunohistochemical parameters, in actinic cheilitis (ACs) and lower lip squamous cell carcinomas (LLSCCs). Methods: Samples of ACs, LLSCCs, and control group (CG) were prepared by tissue microarray (TMA) for immunohistochemical TGF‐β, α‐SMA, and Ki‐67 and histochemical hematoxylin and eosin, picrosirius red, and verhoeff van gieson reactions. Clinical and microscopic data were associated using the Mann–Whitney, Kruskal‐Wallis/Dunn, and Spearman correlation tests (SPSS, p < 0.05). Results: ACs showed higher number of α‐SMA+ MFs when compared to CG (p = 0.034), and these cells were associated with the vertical expansion of solar elastosis (SE) itself (p = 0.027). Areas of SE had lower deposits of collagen (p < 0.001), immunostaining for TGF‐β (p < 0.001), and higher density of elastic fibers (p < 0.05) when compared to areas without SE. A positive correlation was observed between high‐risk epithelial dysplasia (ED) and the proximity of SE to the dysplastic epithelium (p = 0.027). LLSCCs showed a higher number of α‐SMA+ MFs about CG (p = 0.034), as well as a reduction in the deposition of total collagen (p = 0.009) in relation to ACs and CG. There was also a negative correlation between the amount of α‐SMA+ cells and the accumulation of total collagen (p = 0.041). Collagen and elastic density loss was higher in larger tumors (p = 0.045) with nodal invasion (p = 0.047). Conclusions: Our findings show the possible role of MFs, collagen fibers, and elastosis areas in the lip carcinogenesis process. [ABSTRACT FROM AUTHOR]

This article presents a study that analyzed potentially malignant lesions in the oral cavity. The study examined data from 62 patients in Romania and found that older adults, particularly those over 50 years old, had a higher prevalence of these lesions. There was also a gender disparity, with actinic cheilitis being more common in males. The study emphasizes the importance of early detection and regular monitoring to prevent malignant transformation. The study also suggests the potential use of laser treatments as therapeutic alternatives. [Extracted from the article]

Cheilitis is a relatively common lip disease with many etiologies and causes including concomitant mucocutaneous or systemic diseases, which needs multidisciplinary communication. The purpose of this study was to compare the scientometric characteristics of cheilitis publications by multidisciplinary specialists. All the papers on cheilitis were comprehensively retrieved from the Scopus database, and divided into three groups (dermatologists, stomatologists, and other scholars). There were 478 and 241 papers on cheilitis published by dermatologists and stomatologists, respectively. The total citation count was 5838 and the h index was 36 for cheilitis publications by dermatologists, and the total count was 2983 and the h index was 27 for cheilitis publications by stomatologists. Interestingly, we observed that dermatologists preferentially concerned contact cheilitis/dermatitis and plasma cell cheilitis, while stomatologists preferentially concerned cheilitis-related lip neoplasms including squamous cell carcinoma, dysplasia, and precancerous conditions. The most common disorder researched by both dermatologists and stomatologists was actinic cheilitis. The keywords such as patch test, cosmetic, edema, drug efficacy, toothpaste, lipstick, allergens, and granulomatous inflammation were common in dermatologists' publications; while the keywords such as protein expression, metabolism, risk factor, prevalence, malignant transformation, and carcinogenesis were common in stomatologists' publications. This study for the first time reported the scientometric characteristics of cheilitis as an interdisciplinary disease researched by specialists. It highlights that cheilitis-related specialists through reciprocal collaboration and communication will improve the patients' outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Actinic conjunctivitis (AC), along with cheilitis (AChe), is part of the clinical spectrum of actinic prurigo (AP), a rare photo dermatosis that affects high-risk populations. We analyzed the clinical manifestations and onset of actinic conjunctivitis (AC), and its relationship with prurigo (AP) in a susceptible population. Methods: This prospective observational cohort study was performed on Indigenous populations from the highlands of Chiapas, Mexico. Thorough dermatological and ophthalmological examinations were performed in patients attending a primary health care center. The clinical features, labor and environmental factors, onset timing, and clinical staging of AC and AP were analyzed. Results: Of the 2913 patients studied, 54 patients (108 eyes) (1.8%) had AC, and 14 patients (25.9%) had AP. The mean age at diagnosis was 36.18 ± 18.52 years (6–70 years). The mean residential altitude was 1884 ± 434.2 m above sea level. Mean self-reported sun exposure was 5.14 ± 3.1 h a day (0.5—12 h). A total of 90.7% reported exposure to biomass fuels during cooking, and 50% to farm animals. AC was the sole manifestation in 70% of the cases. All patients had nasal and temporal photo-exposed conjunctiva. Among the eyes, 12.9% were classified as stage-1, 64.8% as stage-2, and 22.2% stage-3. A total of 83.3% of the patients had hyperpigmented lesions, and 35.1% had evaporative dry eye disease. Conclusions: AC may be the initial or sole manifestation of AP. Most AC cases (87%) were initially observed at the advanced stages of the disease. Although solar exposure was not associated with late AC stages, a positive association was found with farm animal exposure. Evaporative dry eye associated with meibomian gland dysfunction has not been previously reported in patients with AC. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical application value of reflectance confocal microscopy(RCM) in the diagnosis of actinic cheilitis(AC). Methods After approval by the hospital ethics committee and informed consent given by the patients, from October 2020 to July 2022, 17 patients who were diagnosed with actinic cheilitis in the Ninth People's Hospital affiliated with Shanghai Jiao Tong University School of Medicine were retrospectively analyzed. The white keratotic lesions of the lips were scanned with reflectance confocal microscopy, and the image characteristics were summarized and analyzed, including epithelial hyperplasia/atrophy, hyperkeratosis, inflammatory cell infiltration, blood vessel dilatation, solar elastosis, atypical keratinocytes, widening of intercellular spaces, degeneration of basal cell layer, and pigmentation. We used the sample compliance rate to measure the correlation between RCM parameters and histopathological diagnostic criteria for AC and kappa concordance analysis to calculate the concordance between RCM and pathological diagnosis. Results Under RCM, the sample correct rates for epithelial hyperplasia/atrophy, hyperkeratosis, inflammatory cell infiltration, vasodilation, and solar elastosis were 76.5%, 100%, 100%, 64.7%, and 70.6%, the sample accuracy compared with pathological diagnosis was 82.4%, 47.1%, 94.1%, 88.2% and 76.5%, respectively. We also observed that 100%, 88.2%, 76.5%, and 88.2% of AC patients showed RCM features of atypical keratinocytes, widening of intercellular spaces, degeneration of the basal cell layer, and pigmentation, respectively. The kappa value of hyperkeratosis and inflammatory cell infiltration was 1. The kappa value of blood vessel dilatation was 0.645. Conclusion Reflectance confocal microscopy is noninvasive and versatile and has clinical application value in the diagnosis of actinic cheilitis.

Abstract Lip squamous cell carcinoma (LSCC) accounts for 12% of all head and neck cancers. It is caused by chronic exposure to ultraviolet light solar radiation and related to previous actinic cheilitis (AC). This study aimed to investigate the immunostaining of the putative cancer stem cells (CSC) markers ALDH1 and CD44 in AC (n=30) and LSCC (n=20). ALDH1 positivity was found to be statistically higher in LSCC than in AC lesions (p=0.0045), whilst CD44 expression was statistically higher in AC than in LSCC lesions (p=0.0155). ALDH1+ cells in AC lesions were associated with specific clinical features: a younger age (

Actinic Cheilitis (AC) is a chronic inflammatory lesion that affects the vermilion of the lower lip, caused by chronic exposure to ultraviolet (UV) radiation. Some co-factors are strongly associated with the progression of the disorder to squamous cell carcinoma, such as smoking, immunosuppression, and certain genetic disorders. The treatment of the lesion varies according to the degree of epithelial dysplasia. In less advanced lesions, patients should be encouraged to use lip sunscreen, hats, and reduce sun exposure. In more advanced cases, with clinically relevant changes such as hardening of the edges and thickening of the epithelium and/or mucosa, vermilionectomy is indicated. The objective was to describe a case report diagnosed as AC by the Clinic of the League of Stomatology and Oral Medicine (LAEMO) and to conduct a literature review on the subject. Male patient, 64 years old, with fair skin, referred for evaluation of a lower lip plaque and extraction of two dental elements. The extractions were performed, and an incisional biopsy was performed during the same surgical procedure. The specimen was sent for microscopic analysis to confirm the hypothesis of AC. The diagnosis of AC was confirmed after the association of clinical and laboratory aspects. [ABSTRACT FROM AUTHOR]

Actinic cheilitis is an oral potentially malignant disorder caused by UV radiation leading to damage to epithelial keratinocytes of the lips. It predominantly affects the vermillion border of the lower lip. Due to its association with chronic UV exposure, associated risk factors include geographic areas, outdoor occupations, and skin subtypes. A high proportion of lip squamous cell carcinomas arise from actinic cheilitis lesions, with histological examination usually showing a degree of dysplasia. This paper aims to review the existing literature regarding the clinical picture of actinic cheilitis, its prevalence, differential diagnoses, and consensus on management, for the education of the general dental practitioner in identifying and surveillance of this lesion. [ABSTRACT FROM AUTHOR]

Background: This systematic review aimed to conduct a complete investigation of the demographic aspects, clinicopathological features, degrees of epithelial dysplasia, and malignant transformation rate of actinic cheilitis. Methods: The study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in the International Prospective Register of Systematic Reviews (CRD42020201254). A search without year and language restrictions was performed using PubMed/MEDLINE, Embase, Virtual Health Library, Scopus, Web of Science, and gray literature. Studies that provided information on patients with actinic cheilitis were included, excluding those with general information on other diseases or other types of cheilitis. Risk of bias was explored using the Joanna Briggs Institute tool. Narrative and quantitative data syntheses were performed using meta-analyses and subgroup analyses. Association tests were also performed. Results: Thirteen studies (728 patients) were included. The most prevalent clinical signs were dryness (99%), blurred demarcation between the lip vermilion and skin (82%), scaling (69%), and atrophy (69%). Regarding epithelial dysplasia, a prevalence of mild dysplasia (34.2%), followed by moderate (27.5%), and severe (14.9%). The malignant transformation rate was 14%. Crusts, ulcerations, and erythematous areas were associated with lip carcinoma (p < 0.001), and scaling was associated with actinic cheilitis (p < 0.001). Conclusions: This study revealed several features of actinic cheilitis, providing an overview of the disease. It is suggested that new studies help develop policy guides for the standardization of clinical criteria, enabling more rigorous and homogeneous analysis of actinic cheilitis. [ABSTRACT FROM AUTHOR]

Background: Squamous cell carcinoma of the lip (LSCC) and oral cavity can be life-threatening if not diagnosed early. Precancerous lesions like actinic cheilitis (AC), can transform into LSCC. Laminin is a fundamental component for basement membrane (BM) and its integrity may prevent neoplastic invasion. Therefore, laminin immunostaining of BM may be useful in identifying early invasion in actinic cheilitis and thus in the differential diagnosis between AC and invasive LSCC or high-grade epithelial dysplasia (ED). Materials and methods: Biopsies from 46 patients with oral lesions were histologically analyzed and immunohistochemically stained for laminin-1. Results: AC was diagnosed in 34 patients and LSCC in 12 patients, including 3 patients with AC and concomitant high-grade ED/in situ carcinoma. Laminin-1 immunostaining revealed intense and linear expression of the BM in AC with low-grade ED. Loss of laminin expression was observed in LSCC. Intracellular laminin expression in parabasal cells was noted in AC with high-grade ED/in situ carcinoma. Conclusion: Laminin immunostaining could be useful in identifying AC cases suspected of early invasion. It could also contribute to the histopathological differential diagnosis between AC with low- and high-grade ED and between AC and invasive LSCC. The findings of this study provide new insights into the mechanism involved in the progression process of AC into LSCC, encouraging preclinical studies that may document the stochastic role of laminin in this process. [ABSTRACT FROM AUTHOR]

We present a clinical case of a primary multiple synchronous highly differentiated keratinizing squamous cell skin cancer in an 84-year old patient with multiple actinic keratosis and actinic cheilitis. The clinical case is unique for the simultaneous development of primary multiple squamous cell carcinoma of the tip of the nose and the vermilion zone of the lower lip in a patient with a past occupational and solar burden, a light phenotype, and signs of chronic photo injury the skin. Clinical, dermatoscopic and sonographic signs of keratotic actinic keratosis were identified in the patient and confirmed by pathomorphological examination. The risk factors for malignant transformation of actinic keratosis were found, such as multiple efflorescences and a long disease history. The malignant transformation of the actinic areas manifested as rapidly progressive ulceration zones more than 1 cm in diameter, pronounced hyperkeratosis, inflammation and infiltration of the underlying tissues, increased bleeding and pain. It is to be underlined that definitive and differential diagnosis requires pathomorphological assessment of the skin biopsy sample. This clinical case indicates that patients with multiple foci of actinic keratosis should be under a lifelong follow-up by dermatovenereologists, with mandatory treatment and prevention measure.

Objective: To determine whether sun protection is associated with lower occurrence of actinic cheilitis in adults living in a city from southern Brazil. Materials and Methods: A multi‐stage proportional sample of 404 individuals 18 years and older was obtained. Interviews and clinical examinations were conducted in participants' households. Four categories of self‐reported use of sun protection were determined. Multivariable Poisson regression was used to assess the associations. Results: Prevalence of actinic cheilitis was 47.1%. In the first main‐effects multivariable model, AC was significantly associated with sex, age, skin colour and duration of sun exposure, but not with sun protection. However, the association between sun protection and actinic cheilitis was modified by the time of sun exposure. Among those exposed ≥4 hr/day to sun, individuals using physical protection or physical + chemical protection were 33% (prevalence ratio = 0.67, 95% confidence interval [CI] 0.47–0.94, p =.02) and 36% (PR = 0.64, 95% CI 0.47–0.94, p =.02), respectively, less likely to have actinic cheilitis than those who did not use any sun protection, adjusting for sex, age and skin colour. Conclusions: Physical and chemical sun protection were associated with lower occurrence of actinic cheilitis in individuals with greater exposure to sun. [ABSTRACT FROM AUTHOR]

Introduction: Actinic cheilitis (AC) is the biologic precursor of invasive squamous cell carcinoma (SCC) of the vermilion, and different treatment options have been investigated, but their efficacy is hampered by local inflammation, pain and slow recovery. Daylight photodynamic therapy (dl-PDT) has been demonstrated to represent a valuable treatment option for AC, but its feasibility is limited by weather conditions and latitude. Methods: Our study proposed to compare the efficacy and tolerability of conventional photodynamic therapy (c-PDT) and indoor daylight photodynamic therapy (idl-PDT) with a white LED lamp for the treatment of AC. Sixteen patients were enrolled in the study: 8 (50%) treated with c-PDT and 8 (50%) treated with idl-PDT. All patients completed the study protocol. Results: Both idl-PDT and c-PDT were demonstrated to be highly effective in terms of reduction of the cumulative lesional area and severity of the clinical score. Neither treatment was inferior to the other. The inflammatory reaction and the pain scores were milder with idl-PDT, whereas the cosmetic outcome was not different. Conclusion: The present findings confirm that idl-PDT can represent a valid therapeutic strategy for AC patients as well, despite the procedural difficulties and the risk of poor tolerability related to the body site. [ABSTRACT FROM AUTHOR]

Background: Clinical differentiation between different cheilitis variants may be difficult. Application of mucoscopy, in addition to clinical background, could provide additional diagnostic clues facilitating initial patient management. Objectives: To determine mucoscopic clues differentiating actinic cheilitis from the main forms of inflammatory cheilitis, including eczematous cheilitis, discoid lupus erythematosus, and lichen planus of the lips. Methods: This was a retrospective, multicenter study being a part of an ongoing project "Mucoscopy – an upcoming tool for oral mucosal disorders" under the aegis of the International Dermoscopy Society. Cases included in the current study were collected via an online call published on the IDS website (www.dermoscopy-ids.org) between January 2019 and December 2020. Results: Whitish-red background was found in actinic cheilitis as well as in cheilitis due to discoid lupus erythematous and lichen planus. Polymorphous vessels were more likely to be seen in actinic cheilitis compared to other causes of cheilitis. White scales, ulceration, and blood spots predominated in actinic cheilitis and lichen planus, whereas yellowish scales typified eczematous and discoid lupus erythematous cheilitis. Radiating white lines although most common in lichen planus patients were also seen in actinic cheilitis. Conclusion: Despite differences in the frequency of mucoscopic structures, we have not found pathognomonic features allowing for differentiation between analyzed variants of cheilitis. [ABSTRACT FROM AUTHOR]

Photodynamic therapy (PDT) using 5-aminolevulinic acid (5-ALA) is an emerging treatment option in the care of actinic keratosis (AK). A self-adhesive 5-ALA patch was recently developed that allows a precise PDT procedure. Here, we review the current literature and report the findings of our case series that observed the outcomes and safety of 5-ALA patch PDT. Ten patients with a total of 40 AKs were treated with a single session of conventional or daylight PDT using 5-ALA patch at the Department of Dermatology and Venereology, Sapienza University of Rome or at the European Institute of Oncology, Milan, Italy. Complete response was observed in three patients, while partial response was seen in seven patients. Overall tolerability was good or excellent, with local adverse events observed in four patients. This is the first case series reported where the 5-ALA patch was applied using daylight PDT, and its efficacy and tolerability in the treatment of AK were demonstrated. In conclusion, the self-adhesive 5-ALA patch is a convenient application of PDT that provides a well-tolerated and effective treatment option with satisfactory cosmetic outcomes. [ABSTRACT FROM AUTHOR]

The goal of this study was to clarify the role of p16INK4a, p14ARF, and p53 protein expressions in carcinogenesis in squamous cell carcinomas of the lip. The expressions of the p53, p16INK4a, and p14ARF proteins were examined in 46 formaline-fixed paraffin embedded tissue specimens, which included 19 cases of squamous cell carcinoma of the lip, 14 cases of actinic cheilitis, and 13 cases of normal mucosa. Immunoreactivity in the peritumoral epithelium adjacent to squamous cell carcinomas was also evaluated. p16INK4a expression was increased in actinic cheilitis in comparison with normal mucosa (p=0.001). p14ARF expression progressively increased from normal mucosa to actinic cheilitis (p=0.001) and was observed to decrease significantly during the process of transition from actinic cheilitis to carcinoma (p=0.003). p53 values progressively increased from normal mucosa to actinic cheilitis (p=0.001) and carcinoma (p=0.008). A significant positive correlation was found between p14ARF and p53 in the peritumoral epithelium adjacent to carcinomas. Our findings indicated that p16INK4a and p14ARF immunohistochemistry does not determine whether or not actinic cheilitis has the potential to develop carcinoma. The p14ARF/p53 pathway is activated in the peritumoral epithelium adjacent to carcinoma; however, this activation would not be adequate to prevent carcinogenesis. [ABSTRACT FROM AUTHOR]

The article summarizes information about actinic keratosis, presents modern literature data on the epidemiology of the disease, the features of the clinical picture, diagnosis, differential diagnosis, therapy of the disease. [ABSTRACT FROM AUTHOR]

Background: Squamous cell carcinoma of the lip accounts for 20% of all oral carcinomas. Its diagnosis may be challenging because it clinically resembles actinic cheilitis and inflammatory lesions of the lips. Objectives: To determine clinical and dermatoscopic predictors of squamous cell carcinoma of the lip vs. other lip lesions. Methods: Multicentre retrospective morphological study, including histologically confirmed cases of squamous cell carcinoma of the lip and controls consisting of actinic cheilitis and inflammatory lesions of the lips. Clinical and dermatoscopic images were evaluated for the presence of predefined criteria. Crude and adjusted odds ratios and corresponding 95% confidence intervals were calculated by univariate and multivariate logistic regression respectively. Results: A total of 177 lip lesions were evaluated, 107 (60.5%) were squamous cell carcinomas and 70 (39.5%) were controls. The most frequent dermatoscopic criteria of lip squamous cell carcinoma were scales (100%), white halos (87.3%) and ulceration (79.4%). The majority of squamous cell carcinomas displayed polymorphic vessels (60.8%), with linear (68.6%) and hairpin (67.6%) being the most frequent types. Multivariate logistic regression analysis showed that clinical predictors of lip squamous cell carcinoma were exophytic appearance and clinical hyperkeratosis, with 43‐fold and 6‐fold higher probability respectively. White clods and ulceration in dermoscopy presented a 6‐fold and 4‐fold increased risk for squamous cell carcinoma respectively. Conclusions: A scaly lesion with exophytic growth, dermatoscopically displaying white clods, ulceration and linear and hairpin vessels is very likely a squamous cell carcinoma of the lip. [ABSTRACT FROM AUTHOR]

Objectives: To identify the immunohistochemical pattern of non‐tumoral epithelium adjacent to lip cancer (ANTE) to unveil molecular alterations and potential biomarkers in lip cancer patients. Materials and Methods: A systematic search at MEDLINE, EMBASE and proceedings Web of Science, OpenGrey and WorldCat. The PICOS outline (Population: lip cancer patients; Intervention: immunostaining with biomarkers in surgical specimens; Comparisons: ANTE versus LC; Outcomes: primary—to identify the immunohistochemical pattern of peritumoral epithelium and secondary—to assess the immunoreactivity of LC epithelium; and Study design: cross‐sectional, case‐control and cohort studies). Results: A total of 339 records were identified. Seven studies reporting on ANTE and LCs were included in the qualitative synthesis, and 4 of them (p53 immunostaining) were selected for meta‐analysis. In the ANTE group, the pooled prevalence of p53 was 0.74 (95% CI: 0.66 – 0.82), while in the lip squamous cell carcinoma group this prevalence was 0.83 (95% CI: 0.75 – 0.89). Conclusions: Similar immunoexpression was found in lip epithelium adjacent to lip carcinoma, even in epithelia with normal appearance or mild histological alterations. The role of biomarkers in the follow‐up of actinic cheilitis patients deserves additional clinical assessment. [ABSTRACT FROM AUTHOR]

Lip squamous cell carcinoma (Lip SCC) and actinic cheilitis are chronic lip lesions with quite similar clinical features that can be induced by ultraviolet radiation. This report aimed to describe the differences between lip SCC and actinic cheilitis, and the importance of early diagnosis of both diseases. Case 1, a 78-year-old man visited to the Oral Medicine Clinic with a chief complaint of persistent ulcers on the lower lip for 2 months. He has received various topical medications, but there was no improvement. He is a heavy smoker and alcoholic, and frequently exposed to direct sunlight daily in his workplace. Extraoral examination showed a yellowish ulcer with indurated border on the lower lip. A diagnosis of lip SCC was confirmed by histopathological examination. He had surgical removal of the lesion. Case 2, a 24- year old female caddie admitted to the Oral Medicine Clinic with a chief complaint of painful and persistent dryness and scaly on her lower lip for 3 months. Extraoral examination showed erosions and yellow crusts on the lower lip. A diagnosis of actinic cheilitis was made. The patient was prescribed 0,2% chlorhexidine digluconate gel, ibuprofen, and multivitamins. The lesion showed significant improvement after 14 days of treatment. History taking and response to initial treatment have an important role in the diagnostic process of Lip SCC and actinic cheilitis. Dental practitioners should be aware and competent enough to identify patients with chronic lip lesions that may be malignant lesions or potentially malignant disorders. [ABSTRACT FROM AUTHOR]

Actinic cheilitis (AC) is part of a spectral disease of keratinocyte carcinomas considered by some authors an early stage of in situ squamous cell carcinoma. Treatment options for AC can be lesion and field-directed therapies. Ingenol mebutate (IM) induces rapid and direct cell death and immune responses being able to destruct dysplastic cells. This study enrolled patients with AC to receive IM gel 0.015% for self-application on the lower lip for 3 consecutive days. A biopsy was performed before and after treatment for histopathological and immunohistochemical evaluation. Local skin reactions (LSR) were evaluated. The level of significance considered was 5%. Fourteen patients were enrolled. All LSR had a complete resolution for up to 2 weeks. The most common adverse events were burning sensation, angular cheilitis, and pain. There was an improvement of more than 80% in patients' subjective evaluation. There was no statistically significant histopathological response since all patients remained with mild dysplasia. No reduction in the P53 expression was observed in the current study. Despite being a safe therapeutic method, the absence of histopathological or immunohistochemical response suggests that clinical improvement may not be accompanied by histopathological cure for AC treated with IM. [ABSTRACT FROM AUTHOR]

The article summarizes information about the actinic keratosis. Presented data of the literature about the prevalence of the disease, the features of the clinical picture, diagnosis, differential diagnosis and treatment of dermatosis.

Actinic cheilitis or solar cheilosis is considered a precursor of malignancy or even an in situ squamous cell carcinoma (SCC) of the lip, located most frequently on the lower lip. Actinic cheilitis (AC) has a higher likelihood of developing into invasive SCC of the lip, which is one of the deadliest non-melanoma skin cancers. Risk factors include chronic UV exposure, increasing age, male gender, fair phototypes, chronic scarring, immunosuppressive therapy, and tobacco use. From a clinical point of view, AC is characterized by dryness, scaling, atrophy, indistinct borders, and erosions. Ulceration and the appearance of a nodule often suggest the progression to invasive SCC. Dermoscopic examination reveals white structureless areas, scales, erosions, and white halos of the vermilion. Reflectance confocal microscopy shows disruption of the stratum corneum, parakeratosis, an atypical honeycomb pattern, solar elastosis, and dilated and tortuous blood vessels with increased blood flow. The rate of malignant transformation ranges from 10 to 30% and early diagnoses and treatment are essential in preventing the development of invasive SCC. Optimal treatment has not been established yet, but invasive and topical treatments can be tried. The present paper aims to review the existing data regarding epidemiology, risk factors, clinical picture, non-invasive imaging, diagnosis, and therapy in AC.

Aims: To discuss the terminology to define and classify actinic cheilitis (AC) and to build a consensus on the diagnostic and therapeutic approaches to AC. Methods: Two‐round Delphi study using a questionnaire including 34 closed sentences (9 on terminology and taxonomy, 5 on potential for malignant transformation, 12 on diagnostic aspects, 8 on treatment) and 8 open questions. Experts' agreement was rated using a Likert scale (1–7). Results: A consensus was reached on 24 out 34 statements (73.5%) and on 5 out of 8 (62.5%) close‐ended questions. The response rate was identical in both rounds (attrition of 0%). AC is the term with the highest agreement (median of 7 (strongly agree; IQR: 6–7)) and the lowest dispersion (VC = 21.33). 'Potentially malignant disorder' was the preferred classification group for AC (median of 7) and 85.6% of participants showing some level of agreement (CV < 50). Experts (66.75%) consider AC a clinical term (median: 7; IQR: 4–7) and believe definitive diagnosis can be made clinically (median: 6; IQR: 5–7), particularly by inspection and palpation (median: 5; IQR: 4–6). Histopathological confirmation is mandatory for the management of AC (median: 5; IQR: 2.5–7), even for homogeneous lesions (median: 5; IQR: 3.5–6). Consensus was reached on all treatment statements (VC < 50). Conclusions: AC is a potentially malignant disorder with a significant lack of agreement on diagnostic criteria, procedures, biopsy indications and the importance of techniques to assist in biopsy. A consensus was reached on nomenclature and management of this disorder. [ABSTRACT FROM AUTHOR]

Background: To analyse the clinical and histological characteristics from a series of oral leukoplakias, leukoerythroplakias, erythroplakias and actinic cheilitis diagnosed in a 14‐year period. Methods: The files were reviewed and all cases diagnosed as leukoplakia, leukoerythroplakia, erythroplakia and actinic cheilitis were selected. Clinical information was obtained from the biopsy submission forms, and histological review was performed in all cases. Results: Final sample included 953 lesions, mostly affecting females (534, 56%), and 87.5% of the patients were 41 to 80 years old. The most commonly affected regions were the lower lip (20.1%), tongue (18.1%) and buccal mucosa (16.9%). Leukoplakias, actinic cheilitis, leukoerythroplakias and erythroplakias represented, respectively, 74.6%, 15.2%, 9.3% and 0.8% of the sample. Most cases presented no dysplasia (42.1%) or mild dysplasia (33.5%). Lesions in the tongue, floor of mouth and lower lip, as well as lesions that presented hyperparakeratosis, showed higher frequencies of moderate dysplasia and severe dysplasia/carcinoma in situ. The most common histological criteria were the increase in number and size of nucleoli, loss of polarity of the basal cells and variations in cellular size and shape. Classification by the binary system showed that 7% were high‐risk lesions. Conclusion: All histological criteria for classification of oral epithelial dysplasia recommended by the World Health Organization showed increased frequency as grading increased. Additional criteria seem to be useful in grading oral epithelial dysplasia, such as the presence of normal and abnormal superficial mitotic figures and endophytic epithelial proliferation. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to analyze the expression of miR-181b, miR-21, miR-31, and miR-345 in actinic cheilitis with and without epithelial dysplasia and lower lip squamous cell carcinomas, and to verify if the deregulated expression of these miRNAs would be indicative of malignant transformation. Materials and methods: The sample was selected from formalin-fixed paraffin-embedded tissues of 19 actinic cheilitis without epithelial dysplasia, 32 actinic cheilitis with epithelial dysplasia, 42 lower lip squamous cell carcinomas, and 10 nonaltered oral mucosa of the lip. The microRNA (miR, miRNA) expression was quantified by real-time RT-PCR and the expression of the selected miRNAs among the groups of actinic cheilitis and lower lip cancer was compared by chi-square. Results: A higher expression of miR-181b, miR-31, and miR-345 was found in actinic cheilitis without epithelial dysplasia in comparison to that in actinic cheilitis with epithelial dysplasia and with lower lip cancer. There were no differences in miR-21 expression between actinic cheilitis and lower lip cancer. Hierarchical clustering analysis showed a tendency for a downregulation of miR-181b, miR-21, miR-31, and miR-345 in most patients with lower lip cancers. Conclusions: The upregulation of miR-181b, miR-31, and miR-345 expression in actinic cheilitis without epithelial dysplasia and the decrease in the expression of these miRNAs in actinic cheilitis with epithelial dysplasia and in lower lip cancer are potential biomarkers of malignant progression. Clinical relevance: This miRNA signature can help to identify actinic cheilitis with potential to progress to lip cancer. [ABSTRACT FROM AUTHOR]

To compare two grading systems of epithelial dysplasia—World Health Organization (WHO) and binary system (BS) –in actinic cheilitis (AC). Seventy cases diagnosed as AC in an Oral Pathology Laboratory from Brazil in the last 12 years were retrospectively retrieved, including the demographic data of each patient. All conventionally stained slides were reviewed, and epithelial dysplasia was evaluated by two independent observers using both WHO and BS grading systems. Data correlation was performed using kappa and chi-square tests (p < 0.05). Most patients were white men with a mean age of 57 years old and history of chronic exposure to sunlight. Most of the lesions were clinically described as whitish plaques with irregular surface located in the lower lip semi-mucosa. Most cases were microscopically graded as severe epithelial dysplasia and low-risk by both observers. The interobserver and intraobserver agreement between systems was slight. All reddish lesions were graded as severe epithelial dysplasia, showing an equal distribution between low and high-risk grading. Most ulcerated lesions showed severe epithelial dysplasia but was graded as low-risk of malignant transformation. Statistical significance was observed among the presence of "irregular stratification", severe epithelial dysplasia and high-risk lesions (p < 0.05) likewise among the presence of "loss of polarity of basal cells" and "drop-shaped ridges" (p < 0.05) with high-risk lesions. The absence of "increased mitotic figures", "dyskeratosis" and "keratin pearls" (p < 0.05) were strongly correlated to low-risk lesions. The presence of "hyperchromasia" was statistically significant with severe epithelial dysplasia (p < 0.05) as well the absence of "atypical mitotic figures" with low-risk lesions (p < 0.05). Although there was slight agreement between microscopic grading systems, microscopic analysis indicated that architectural epithelial changes individually may be the more reliable criteria to indicate the risk of malignant transformation in AC in both grading systems. [ABSTRACT FROM AUTHOR]

We report a case of actinic cheilitis. A 74-year-old male presented with an intractable erosive lesion on the vermilion border of the lower lip. Based on biopsy results, the patient was diagnosed with actinic cheilitis and referred to our department for surgical treatment. A simple local resection procedure with direct closure was performed under local anesthesia. The surgical margin was 2 mm. Two weeks after the operation, the wound was found to have dehisced but closed with conservative treatment. Histopathologic results revealed a defective epidermis, solar elastosis in the dermis, atypical cells with swollen nuclei, and mitosis in the vicinity of the basal lamina. Two years after the operation, no recurrence was noted and there was no complaint of trismus. Since actinic cheilitis has no distinguishing features, affected patients are often diagnosed with eczema and receive conservative treatment, which is sometimes continued without further examination. However, this is a precancerous lesion with poor prognosis if malignancy develops, thus an aggressive biopsy procedure should be performed for cases with long-term lip erosion. Additionally, careful consideration must be given to the surgical protocol used for treatment. [ABSTRACT FROM AUTHOR]

Background: Actinic cheilitis (AC) is a premalignant lesion of the lips that can evolve into squamous cell carcinoma. Among nonsurgical treatments, photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA) patch might represent a new noninvasive therapeutic approach for AC. Objective: We sought to investigate the potential role of fractional CO2 laser pretreatment in boosting ALA penetration and distribution into AC treated with PDT. Methods: We report a case of a woman with AC on the lower lip, treated with ablative fractional CO2 laser to boost drug delivery of 5-ALA patch before PDT treatment. Reflectance confocal microscopy was performed to assess diagnosis and treatment response. Results: We detected a good clinical and cosmetic outcome after two applications of combined treatment. Erythema, crust, and edema were reported as side effects. Conclusions: This case report shows that ablative fractional CO2 laser-assisted PDT might be an effective therapeutic alternative for patients with AC who refuse or are contraindicated for surgical procedures. [ABSTRACT FROM AUTHOR]

Cheilitis Glandularis (CG) is a chronic inflammatory disorder with no specific etiology that affects the minor salivary glands of the lips. The main characteristic of this condition consists of the exit of thick saliva or mucopurulent secretion through the dilated ducts present in the vermilion border of the lip, associated to varying degrees of macrocheilia. In this article we report the case of a male patient, leucoderma, 48 years old, that exhibited actinic cheilitis and glandular cheilitis. We emphasized the clinical management, diagnosis criteria and treatment, taking into consideration that GC is a rare condition and makes a differential diagnosis with other entities that may occur on lips. Although a diagnosis of CG is not difficult, its treatment is a challenge, considering the unknown etiology that hinders the development of more specific and effective treatments. [ABSTRACT FROM AUTHOR]

Background: When treating actinic cheilitis (AC), it is essential to minimize the risk of malignant transformation (MT) and maintain lip functionality and cosmesis. Aims: We evaluated the outcomes of vermilionectomy followed by reconstruction of the vermilion mucosa using allograft dermal matrix (ADM) in patients with AC of the lower lip. Materials and methods: We evaluated eight patients with lower lip AC who underwent vermilion mucosa reconstruction using ADM after vermilionectomy. We enrolled five males and three females ranging in age from 55 to 70 years (mean, 62.1 years). The ADM ranged in area from 1.3 × 5.0 to 1.7 × 5.8 cm (median, 1.6 × 5.5 cm). All patients were followed up for at least 3 months postoperatively by a panel of three surgeons who assessed the esthetic results, and orbicularis oris and speech functions. Results: All patients underwent successful reconstruction of the vermilion mucosa using ADM after vermilionectomy, without complications. The postoperative esthetic results, and the orbicularis oris and speech functions, were satisfactory to excellent in all patients. Patients were followed up for 18‐38 months (median, 26.1 months). No MT or recurrence was noted. Conclusions: Vermilionectomy followed by reconstruction of the vermilion mucosa with ADM is safe and feasible for AC patients. [ABSTRACT FROM AUTHOR]

Early identification and adequate treatment of actinic cheilitis (AC), which affects the lower lip vermillion and is considered a precursor of squamous cell carcinoma, is mandatory. Photodynamic therapy (PDT) has been successfully used in AC. PDT with the use of daylight (DLPDT) is equally effective and more convenient than the conventional PDT. Data on short and long-term efficacy of DLPDT in AC are limited. Our primary purpose was to assess efficacy of DLPDT in AC as well as safety and tolerance. Twenty-two individuals with histologically confirmed AC received 2 MAL (5-aminolevulinic acid)-DLPDT sessions 1 week apart. Patients were evaluated clinically 3, 6, and 12 months after treatment. Non-complete responders were biopsied and excluded from the study if histological alterations were indicative of AC. Adverse events were recorded from baseline to the end of the 12-month follow-up period. Twenty patients completed the study. Overall, complete clinical response 12 months after treatment was 80% (16/20), while an association between treatment response and grade of dysplasia was observed (p = 0.016). With respect to response by grade, complete clinical response achieved in grade I AC was 100% (12/12) and 50% (4/8) in grade II AC. Main adverse events included mild erythema, oedema, and scaling, with no pain associated with DLPDT. According to our results, DLPDT seems to be of significant benefit for the treatment of grade I AC. Combination with the other treatment modalities could improve the efficacy in grade II AC. Further studies are needed for the assessment of late recurrences. [ABSTRACT FROM AUTHOR]

Data on the occurrence and clinicopathological characteristics of actinic cheilitis (AC) and lip squamous cell carcinoma (LSCC) are well studied; however, they are based on studies limited to a single centre. Herein, we described the frequency of AC and LSCC submitted to microscopic examination from representative geographic regions of Brazil. A retrospective multicentre study was performed on biopsies obtained from 1953 to 2018 at 10 Brazilian oral and maxillofacial pathology centres. A total of 198,709 biopsy specimens were surveyed. Sociodemographic data and clinicopathologic characteristics were analysed. A total of 2017 cases of ACs (1.0%) and 850 cases of LSCCs (0.4%) were recorded. A strong fair-skinned (> 87%) male (> 70%) predilection was observed in both conditions. The mean age was 54.8 ± 18.7 for individuals with AC and 57.8 ± 19.0 for individuals with LSCC. The most commonly affected site was the lower lip (> 90%). This is a large multicentre study of AC and LSCC from Brazil. The frequency and clinicopathological features of AC and LSCC were similar to those described worldwide. This study provides robust and representative epidemiological data of these conditions for the scientific community. [ABSTRACT FROM AUTHOR]

Although cheilitis as a term describing lip inflammation has been identified and recognized for a long time, until now there have been no clear recommendations for its work-up and classification. The disease may appear as an isolated condition or as part of certain systemic diseases/conditions (such as anemia due to vitamin B12 or iron deficiency) or local infections (e.g., herpes and oral candidiasis). Cheilitis can also be a symptom of a contact reaction to an irritant or allergen, or may be provoked by sun exposure (actinic cheilitis) or drug intake, especially retinoids. Generally, the forms most commonly reported in the literature are angular, contact (allergic and irritant), actinic, glandular, granulomatous, exfoliative and plasma cell cheilitis. However, variable nomenclature is used and subtypes are grouped and named differently. According to our experience and clinical practice, we suggest classification based on primary differences in the duration and etiology of individual groups of cheilitis, as follows: 1) mainly reversible (simplex, angular/infective, contact/eczematous, exfoliative, drug-related); 2) mainly irreversible (actinic, granulomatous, glandular, plasma cell); and 3) cheilitis connected to dermatoses and systemic diseases (lupus, lichen planus, pemphi-gus/pemphigoid group, ­angioedema, xerostomia, etc.).

Actinic cheilitis (AC) is a sun-induced premalignant lesion. AC is a clinical term housing a wide pathological spectrum ranging from hyperkeratosis to invasive squamous cell carcinoma. The aim of this systematic review was to examine the therapeutic efficacy of different approaches in clinical, histological, and cosmetic terms, and the malignization rate after treatment. A systematic search was undertaken in October 2016 and updated in April 2019 at MEDLINE (from 1966), Embase (from 1980), and Proceedings Web of Science (Conference Proceedings Citation Index-Science (CPCI-S) from 1990) databases. The search strategy was (("actinic" or "solar") AND ("cheilitis")) using both medical subject headings (MeSH) and freetext. A total of 392 potentially eligible reports were identified. After the selection procedure, 20 articles were included. It was concluded that surgical treatment is the first line of treatment for AC and has proved useful for the clinical and pathological control of the disorder. However, there was no evidence of effective treatment in preventing malignant transformations. Non-surgical procedures showed less consistent results, although drug therapy may improve the results obtained by other therapeutic approaches. [ABSTRACT FROM AUTHOR]

Background: No large studies have defined the best treatment of actinic cheilitis.Methods: We conducted a systematic review to define the best therapies for actinic cheilitis in clinical response and recurrences.Results: We first identified 444 papers, and 49 were finally considered, including 789 patients and 843 treated areas. The following therapies were recorded in order of frequency: laser therapy, photodynamic therapy (PDT), 3% diclofenac in 2.5% hyaluronic acid, PDT + 5% imiquimod, aminolevulinic acid-laser or methyl-aminolevulinic acid-laser, 5% imiquimod, fluorouracil, partial surgery, 0.015% ingenol mebutate, 50% trichloroacetic acid, and laser + PDT. Concerning the primary outcome, complete clinical response was achieved in 76.5% of patients, and 10.2% had clinical recurrences. Partial surgery and laser therapy showed the highest complete response rates (14 of 14 [100%] and 244 of 260 [93.8%], respectively) with low recurrences. Only a limited number of patients were treated with other therapies, with the exception of PDT, with 68.9% complete responses and 12.6% of recurrences. Interestingly, when combined with 5% imiquimod, the efficacy of PDT was significantly enhanced.Limitations: Heterogeneity across studies.Conclusion: Laser therapy appears the best option among nonsurgical approaches for actinic cheilitis, and PDT showed higher efficacy when sequentially combined with 5% imiquimod. Larger studies are needed to confirm these data. [ABSTRACT FROM AUTHOR]