Actinic Cheilitis: When a Chapped Lip May Be More Than Dry Skin
Dry, rough, or scaly lips are common, especially during cold or dry weather. But when these changes persist—particularly on the lower lip—they may sometimes represent a condition called actinic cheilitis.
Actinic cheilitis is caused by long-term sun exposure and is considered a precancerous change of the lip. It is closely related to actinic keratoses, the rough or scaly sun-damaged spots that commonly develop on the face, scalp, arms, and hands.
What Does Actinic Cheilitis Look Like?
Actinic cheilitis most often affects the lower lip because it receives considerably more sun exposure than the upper lip. Changes may include:
- Persistent dryness or scaling
- Rough or sandpaper-like areas
- Cracking or peeling
- White, pale, or discolored areas
- Blurring of the normally sharp border between the lip and surrounding skin
- Tender or crusted areas
The changes may involve a small portion of the lip or extend across much of the lower lip.
Because actinic cheilitis can initially resemble ordinary chapped lips, patients may have it for months or years before realizing that something else is occurring.
Why Is Actinic Cheilitis Important?
Actinic cheilitis results from cumulative ultraviolet (UV) damage and can eventually progress to squamous cell carcinoma (SCC) of the lip. This is particularly important because squamous cell carcinoma involving the lip has a greater risk of spreading (metastasizing) than many squamous cell carcinomas arising at other locations on the skin.
Most areas of actinic cheilitis do not suddenly become skin cancer. However, persistent changes deserve evaluation because it can sometimes be difficult to determine by appearance alone whether an area remains precancerous or has developed into an early squamous cell carcinoma.
Changes such as a persistent sore, increasing tenderness, bleeding, crusting, thickening, or a firm area are particularly important to have examined.
Is a Biopsy Necessary?
Not every case of actinic cheilitis requires a biopsy.
If the changes are relatively uniform and clinically typical, treatment may sometimes be recommended without first performing a biopsy. However, if one portion of the lip appears thicker, ulcerated, crusted, tender, or otherwise different from the surrounding areas, a biopsy may be appropriate to determine whether squamous cell carcinoma has developed.
How Is Actinic Cheilitis Treated?
Treatment depends on the extent and severity of the changes.
When a relatively small area is involved, treatment may be directed specifically at that area. When sun damage affects much of the lower lip, a “field treatment” that addresses the broader area of damaged skin may be more appropriate.
Treatment options can include topical medications such as 5-fluorouracil, cryotherapy, laser treatment, and other procedures. The best approach depends on the clinical appearance, extent of involvement, previous treatments, and whether there is concern for an underlying skin cancer.
If a biopsy demonstrates squamous cell carcinoma, treatment is directed at the cancer rather than the surrounding precancerous changes.
Can Actinic Cheilitis Come Back?
Yes. Treatment removes or improves the abnormal areas that are present, but it cannot eliminate the accumulated sun damage that caused them.
Continued protection of the lips from the sun is therefore important. A lip balm containing broad-spectrum SPF 30 or higher, reapplied regularly when outdoors, can help reduce additional UV exposure. Hats and other sun-protective measures are also useful.
When Should a Persistently Chapped Lip Be Evaluated?
Ordinary chapped lips generally improve when the environmental cause resolves and appropriate moisturizers are used.
A persistently rough, scaly, crusted, tender, or discolored area—particularly on the lower lip—deserves evaluation if it does not resolve.
Actinic cheilitis is common and treatable. More importantly, recognizing it provides an opportunity to treat sun-damaged precancerous tissue before it potentially progresses to squamous cell carcinoma.