Actinic Cheilitis

Actinic cheilitis is a precancerous condition affecting the lips, caused by years of sun exposure that creates rough, scaly patches — particularly on the lower lip. Without proper treatment and protection, this condition can transform into a serious form of skin cancer.

Table of contents

• What is actinic cheilitis?
• Other names for this condition
• Medical identification codes
• What causes actinic cheilitis?
• Who is most at risk?
• Signs and symptoms
• How is it diagnosed?
• Risk of cancer
• Treatment options
• How to prevent actinic cheilitis
• What to expect

What is actinic cheilitis?

Actinic cheilitis is a precancerous condition that affects the lips, particularly the lower lip. The term “precancerous” means that abnormal cells are present that can potentially develop into cancer if left untreated^[1].

This condition creates rough, scaly, discolored patches on your lips that result from long-term exposure to sunlight. The word “cheilitis” means inflamed lips, while “actinic” refers to damage caused by ultraviolet light^[1].

Actinic cheilitis is a form of actinic keratosis, which are precancerous skin growths that may occur anywhere on the body. What makes actinic cheilitis particularly concerning is that it can eventually turn into squamous cell carcinoma (SCC), a type of skin cancer^[1].

Other names for this condition

Actinic cheilosis, Solar cheilitis, Solar cheilosis, Sailor’s lip, Farmer’s lip

Medical identification codes

L56.8

What causes actinic cheilitis?

Actinic cheilitis is caused by genetic damage to skin cells from ultraviolet light (UV) rays, particularly from sun exposure or tanning beds^[1]. Your lips are more vulnerable to the sun’s rays than other areas of skin for several important reasons.

The skin on your lips is much thinner than the skin on other parts of your body. It also contains less pigment (the natural coloring in skin that provides some protection from UV rays) and has fewer oil glands. Additionally, the shape of the lips and their position on the face make them especially exposed to sunlight^[2].

Repeated, long-term exposure of your lips to solar ultraviolet radiation causes the condition. The lower lip is affected more often than the upper lip — about 90% of the time — because it tends to be more prominent and receives more direct sunlight^[3].

Chronic exposure to UV light damages a tumor suppressor gene called p53. This gene normally helps control cell growth. When it’s damaged, cells can multiply in an uncontrolled way, leading to precancerous changes^[2].

Who is most at risk?

Anyone can develop actinic cheilitis, but certain groups of people are at higher risk^[1]:

• People with fair skin: Those with less natural pigmentation have less built-in protection against UV rays
• Men: They’re more likely to be outdoor laborers who are frequently exposed to the sun and less likely to use sun-protective lip products
• People over age 60: Older individuals may have had more exposure to the sun over the years, and the condition rarely affects those under 45
• Outdoor workers: Sailors, farmers, lifeguards, fishermen, construction workers, and others who spend significant time outdoors
• People living near the equator or at high altitudes: UV radiation is stronger in these locations
• Those with genetic conditions affecting pigmentation: Such as albinism
• People with weakened immune systems: They have a higher risk of developing the condition and of it progressing to cancer

The prevalence of actinic cheilitis is higher among fair-skinned populations. In one study in northwestern Spain, about 31% of people over age 45 had the condition^[2].

Signs and symptoms

Actinic cheilitis usually develops gradually over time. In the early stages, it may simply look and feel like very chapped lips that never seem to heal no matter how much lip balm you apply^[5].

With actinic cheilitis, the skin on one or both lips may look or feel^[1]:

• Chapped all the time
• Dry
• Cracked or fissured
• Crusty
• Scaly
• Rough, like sandpaper
• Discolored, with white, yellow, or gray patches, or lips that are redder than normal
• Swollen or puffy
• Thin or fragile
• Folded or wrinkled in spots

One distinctive sign is the loss of the sharp border between your lip and the surrounding skin. This border is called the vermilion border — the reddish-colored line that normally separates the lips from other facial skin. Women sometimes notice difficulty applying lipstick because the lip line becomes less defined, and lipstick tends to “bleed” into the surrounding wrinkles^[3].

Actinic cheilitis is usually painless. However, some people might experience^[1]:

• Burning sensation
• Numbness
• Pain
• Soreness
• Tenderness

In more advanced stages, the affected area may become thicker, harder, or develop persistent ulcers (open sores) or crusting^[3].

How is it diagnosed?

If you have symptoms of actinic cheilitis, you should see your healthcare provider. They will examine your lips carefully to determine whether you have simple inflammation, actinic cheilitis, squamous cell carcinoma, or another condition^[1].

Your healthcare provider may diagnose actinic cheilitis based on^[1]:

• Physical examination of your lips
• Questions about your lifestyle, such as the amount of time spent outdoors, use of sun protection, and personal or family history of cancer
• A skin biopsy, which involves taking a small sample of skin tissue to examine under a microscope for more detailed analysis

Actinic cheilitis is often diagnosed clinically based on appearance. However, a biopsy may be recommended if your doctor suspects skin cancer or needs to rule out other causes of lip inflammation. Interestingly, many spots thought to be actinic cheilitis turn out to be squamous cell carcinoma after tissue analysis, which shows doctors cannot always rely solely on appearance^[7].

A biopsy may show changes such as partial thickness epidermal dysplasia (abnormal cell development), thickening or thinning of the lip tissue, and damage to the deeper layers of skin^[3].

Risk of cancer

Actinic cheilitis is considered a premalignant condition because it can progress to cancer^[3]. Without treatment, about 10% of cases may develop into squamous cell carcinoma^[8].

Squamous cell carcinoma on the lips is particularly serious. It is considered a high-risk form of skin cancer with an 11% chance of spreading to other parts of the body (a process called metastasis). This is much higher than squamous cell carcinoma found on other parts of the body, which has only a 1% chance of spreading^[2].

You should suspect that squamous cell carcinoma may be developing if^[3]:

• The lip becomes focally tender (painful in one specific spot)
• A persistent ulcer develops
• An enlarging nodule (lump) appears
• The lesion hardens significantly
• The lesion doesn’t respond to treatment

Additional risk factors that can increase the chance of actinic cheilitis progressing to cancer include smoking, alcohol abuse, infection with certain types of human papillomavirus (HPV), and having a weakened immune system^[3].

Treatment options

Because actinic cheilitis can turn into cancer, it’s important to discuss treatment options with your healthcare provider. They will recommend strategies depending on how severe the condition is, how widespread the affected area is, and your overall health^[1].

The goal of treatment is to remove or destroy the abnormal cells and reduce the risk that the condition will progress to squamous cell carcinoma. Treatment options include medications applied to the skin and procedures performed in a medical office^[1].

Topical medications

These are creams or gels applied directly to the lips to kill affected cells. Topical therapies are often preferred for patients with multiple thin lesions, as more aggressive treatments might cause unwanted cosmetic results^[13]. Common medications include^[1]:

• Topical retinoids: Vitamin A-based medications that help normalize cell growth
• 5-fluorouracil (5-FU) cream: A chemotherapy medication applied to the skin, typically used once or twice daily for 2 to 3 weeks. The most common side effect is irritated skin. Pregnant people should avoid this cream
• Imiquimod cream: A medication that stimulates the immune system to fight abnormal cells
• Diclofenac gel: An anti-inflammatory medication that may help treat precancerous lesions

It’s important to note that these topical therapies for actinic cheilitis are not officially approved for this use, but doctors may recommend them based on their effectiveness^[3].

Physical procedures

Several office-based procedures can remove or destroy abnormal tissue^[1]:

• Cryotherapy: Uses extremely cold temperatures (liquid nitrogen) to freeze and destroy abnormal cells. This is a relatively quick procedure that works well for smaller lesions
• Electrocautery: Uses heat from an electric current to destroy abnormal tissue
• Laser ablation: Uses a focused beam of light (such as a carbon dioxide laser) to remove damaged cells. This treatment has shown excellent cosmetic results with few recurrences
• Photodynamic therapy: A procedure that uses a special light-activated medication applied to the skin, followed by exposure to specific wavelengths of light to kill harmful cells
• Vermilionectomy: Surgical removal of the outer layer of the lip. This procedure, along with carbon dioxide laser treatment, has shown the most favorable outcomes with fewer recurrences compared to other methods

Research indicates that vermilionectomy and carbon dioxide laser treatment produce the best results with lower recurrence rates compared to chemical peels and photodynamic therapy^[3].

How to prevent actinic cheilitis

The best way to prevent actinic cheilitis is to protect your lips from sun exposure^[3]. Taking preventive measures is crucial because this is a chronic condition that can lead to serious complications.

Here are important steps you can take to protect your lips^[1][3]:

• Limit sun exposure: Avoid spending excessive time in the sun, especially between 10 a.m. and 2 p.m. when UV radiation is at its peak
• Use protective lip products: Apply lip balm with a sun protection factor (SPF) of 15 or higher frequently throughout the day. Look for broad-spectrum products that protect against both UVA and UVB rays
• Wear protective gear: Use a wide-brimmed hat that shades your face and lips
• Consider additional barriers: Men can consider growing a mustache for added protection
• Use sun-blocking agents: Products containing zinc oxide or titanium oxide provide physical barriers against UV rays
• Avoid tanning beds: These emit harmful UV radiation that can damage your lips
• Stop smoking: If you smoke, quitting can reduce your risk of actinic cheilitis progressing to cancer

If you cannot avoid sun exposure due to your profession, incorporating these protective measures into your daily routine is essential. People who work outdoors should be especially vigilant about regular use of sun protection^[18].

What to expect

The tissue damage in actinic cheilitis is irreversible, meaning the changes that have already occurred cannot be undone. However, sun protection at any stage can prevent further damage from developing^[17].

With appropriate treatment and consistent sun protection, actinic cheilitis can improve. However, continued sun exposure and lack of treatment increase the risk of developing squamous cell carcinoma, which can be potentially life-threatening^[3].

If caught and treated early, squamous cell carcinoma of the lip has a good prognosis. All patients with a history of actinic cheilitis or lip cancer require regular follow-up examinations to monitor for new changes or recurrences^[17].

If you have been diagnosed with actinic cheilitis, you should^[1]:

• Follow your healthcare provider’s treatment recommendations
• Use sun protection daily, year-round
• Attend all scheduled follow-up appointments
• Monitor your lips regularly for any changes
• Report any new symptoms, hardening, persistent ulcers, or enlarging lumps to your doctor immediately

It’s worth noting that if you have actinic cheilitis, you may also have actinic keratoses (similar precancerous lesions) on other sun-exposed areas of your body, such as your scalp, ears, face, and hands. Your healthcare provider may examine these areas as well^[3].