What is it?
Actinic cheilitis is a lasting change that develops in a lip exposed to sunlight over many years. It is almost always seen on the lower lip, because the lower lip is one of the parts of the face that meets the sun most directly. It is more common in people who work outdoors, in fair-skinned people and in smokers, and it appears earlier in places where the hours spent in the sun are long.
Its appearance is a quiet one: the lip stays dry and flaky all the time, thin whitish areas form, and the sharp border between the red part of the lip and the skin is lost. Some spots harden and form a crust, and after the crust falls off it comes back in the same place. There is usually no pain. It is different from cracks at the corners of the mouth; actinic cheilitis settles across the red surface of the lower lip in general, not in the corner.
This change is not cancer, but it is regarded as precancerous; squamous cell cancer of the lip usually develops on this background. Telling which area is progressing by looking alone is not reliable. That is why a tissue sample taken from a suspicious area is what decides the matter.
Signs
You will not necessarily have all of these at once.
Why does it happen?
- 01
Long-term ultraviolet exposure
The harm comes not from a single sunburn but from the total of many years. Reflection from the sea and from open surfaces adds to that total. Because the protective pigment and oil layer are weak on the lower lip, the damage settles there more quickly.
- 02
Personal susceptibility
Fair skin, light eye colour and skin that burns easily increase the risk. In people having treatment that suppresses the immune system, the change may be earlier and more widespread. Older age also raises the risk, because the total exposure has built up.
- 03
Smoking and ongoing dryness
The heat of a cigarette and the substances in it wear the surface of the lip down further. Breathing through the mouth, constant lip licking and dryness keep the flaking going by upsetting the way the surface repairs itself. These factors are added on top of the sun damage.
- 04
Leaving the lip unprotected
Most people put sun cream on the face and skip the lip. Protection on the lip is reduced within a short time by eating, drinking and talking; when it is not reapplied, that protection largely disappears. This detail explains why the damage is concentrated on the lip.
How does it progress?
- 1
Early change
The lip stays dry and slightly flaky whatever the season, and the sharpness of the lip border begins to fade. There are few symptoms; most people take it for cracking that has become a habit.
- 2
Established change
Whitish, rough and thickened areas become permanent and the surface looks uneven. It may improve for a while with moisturiser, but it goes back to how it was within a short time.
- 3
A suspicious area
Hardening, a raised area, easy bleeding or a sore that does not heal appears at a single spot. None of these findings is the usual course of this condition; a tissue sample is taken without delay and assessed.
- Monitoring
The period after treatment
Even once the changed area has been removed, the whole lip is sun-damaged ground. Because new areas can appear, check-ups are carried on at intervals.
How is it treated?
The dentist's job begins here: the lip is assessed at every mouth examination, the borders and appearance of the area are recorded, and the lip is checked for any spot that has hardened or turned into a sore. The diagnosis is not made by looking; a tissue sample has to be taken from the suspicious area, and that is carried out by oral and maxillofacial surgery or by dermatology.
The choice of treatment is made by those departments, according to the biopsy result and how widespread the change is. In limited areas, medicines applied to the surface of the lip, treatment using light, and removal by freezing or with a laser may come up; where the change is widespread, surgical removal of the red surface of the lip is considered. It is not for a dentist to decide which method is right.
The dentist's role carries on after treatment as well: the lip is assessed again at check-ups, guidance is given on sun protection and on giving up smoking, and added factors such as a sharp tooth edge or an ill-fitting denture that keeps irritating the lip are dealt with. Even if the change has settled, yearly monitoring is advised.
- A sore on the lip that has not healed in two weeks, or a crust that keeps coming back in the same place, is not expected.
- If a hardened, raised or easily bleeding area has developed, it needs assessment.
- If numbness in the lip or a rapidly growing swelling has appeared, do not delay.
- If you can feel a firm, painless gland under your jaw, see a clinician the same week.
How is it prevented?
- Use a high-protection product made for the lips every day and reapply it every few hours during the day.
- Cut down the time you spend outdoors in the middle of the day when the sun is at its most direct; a wide-brimmed hat shades the lip as well.
- Give up smoking; the heat and the chemical effect are added on top of the sun damage.
- Have a mouth examination that includes the lips at least once a year, and keep an eye on any changing area yourself in the mirror.
Frequently asked questions
- My lip is cracked all the time; is this actinic cheilitis?
- Not every bit of cracking points to this condition. Cracking is common in dry weather, when you breathe through your mouth or when you have a lip-licking habit, and it improves with moisturiser. In actinic cheilitis the dryness carries on whatever the season, the border between lip and skin blurs, and any improvement does not last. An examination makes the distinction.
- Will this change definitely turn into cancer?
- No, there is no such certainty. Not everyone with actinic cheilitis goes on to develop cancer. Even so, because cancer of the lip usually appears on this background, the change is regarded as a finding that needs monitoring. The point of monitoring is to catch an area that is progressing early and to prevent delay.
- Is a biopsy essential?
- Appearance on its own does not tell the two apart. If there is hardening, a raised area or a sore that does not heal, a tissue sample is asked for. The sample shows whether the area carries only sun damage or whether there is a change at the level of the cells. Without that information the right treatment cannot be chosen.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.