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Actinic Cheilitis

Actinic cheilitis results from excessive exposure to sunlight and affects primarily the lower lip. Fair-skinned men who work outdoors are most often affected. The lip loses its normal redness and may become scaly, somewhat thickened, and slightly everted. Because solar damage also predisposes to carcinoma of the lip, be alert to this possibility.

Carcinoma of the Lip

Like actinic cheilitis, carcinoma usually affects the lower lip. It may appear as a scaly plaque, as an ulcer with or without a crust, or as a nodular lesion, illustrated here. Fair skin and prolonged exposure to the sun are common risk factors.

(Sources of photos: Herpes Simplex, Angular Cheilitis—From Neville B et al: Color Atlas of Clinical Oral Pathology. Philadelphia, Lea & Febiger, 1991. Used with permission; Actinic Cheilitis—From Langlais RP, Miller CS: Color Atlas of Common Oral Diseases. Philadelphia, Lea & Febiger, 1992. LJsed with permission; Carcinoma of the Lip—Tyldesley WR: A Colour Atlas of Orofacial Diseases, 2nd ed. London, Wolfe Medical Publications, 1991.)

Angioedema

Angioedema is a diffuse, nonpitting, tense swelling of the dermis and subcutaneous tissue. It develops rapidly, and typically disappears over subsequent hours or days. Although usually allergic in nature and sometimes associated with hives, angioedema does not itch.

Telangiectasias Mouth

Hereditary Hemorrhagic Telangiectasia

Multiple small red spots on the lips strongly suggest hereditary hemorrhagic telangiectasia. Spots may also be visible on the face and hands and in the mouth. The spots are dilated capillaries and may bleed when traumatized. Affected people often have nosebleeds and gastrointestinal bleeding.

Chancre of Syphilis

This lesion of primary syphilis may appear on the lip rather than on the genitalia. It is a firm, buttonlike lesion that ulcerates and may become crusted. A chancre may resemble a carcinoma or a crusted cold sore. Because it is infectious, use gloves to feel any suspicious lesion.

Peutz-Jeghers Syndrome

When pigmented spots on the lips are more prominent than freckling of the surrounding skin, suspect this syndrome. Pigment in the buccal mucosa helps to confirm the diagnosis. Pigmented spots may also be found on the face and hands. Multiple intestinal polyps are often associated.

(Sources of photos: Angioedema—From Neville B et al: Color Atlas of Clinical Oral Pathology. Philadelphia, Lea & Febiger, 1991. LJsed with permission; Chancre of Syphilis— Wisdom A: A Colour Atlas of Sexually Transmitted Diseases (2nd ed.) London, Wolfe Medical Publications, 1989; Hereditary Hemorrhagic Telangiectasia—From Langlais RP, Miller CS: Color Atlas of Common Oral Diseases. Philadelphia, Lea & Febiger, 1992. LJsed with permission; Peutz-Jeghers Syndrome—Robinson HBG, Miller AS: Colby, Kerr, and Robinson's Color Atlas of Oral Pathology. Philadelphia, IB Lippincott, 1990.)

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