Brooke DeRouen

MacKenzie Locke
Alyssa Shepard
Oral Pathology
Case Study Report

At examination, the 55-year- old male patient presented with a painless blotchy area, as well as

an irregular mottling vermilion on the lower lip. The lips appeared pale, blotchy, and red with

keratosis. When questioned about the history of this lesion, he stated there was no bleeding or

crusting, but it had been present for about a year. The patient had been an outdoor

construction worker for more than 25 years, which contributed to an increased exposure to the

sun. Besides an allergy to penicillin, the patient seemed to have a good health history. The

patient’s vitals were all within normal limits which wouldn’t indicate any signs of infections

present. Based on the evidence we have gathered with this case study, we have diagnosed the

patient with actinic cheilosis, or solar cheilitis. Although the risk is greater for the lower lip, both

lips can be involved in this condition. It is more common in men than it is in women and it

increases with age and sun exposure. It is important to be aware that this condition is more

likely to develop into squamous cell carcinoma compared to actinic keratosis and should be

examined as necessary.

It cannot be malignant melanoma because this typically occurs on the maxillary gingiva,

frequently on the palate. In this case, the lesion is found on the outside of the lower lip. Also,

malignant melanoma has darkened patches on the gums, and they grew larger overtime and

our patients’ lesion was not dark it was blotchy and pale.
Although basal cell carcinoma is also associated with sun exposure, it cannot be this because

there is no ulcer present and is located in/on the oral cavity. Basal cell carcinoma is a malignant

skin tumor, which is located on surface of the face. It presents as a small discrete, sessile,

exophytic lesion or ulcer. This is typically surgically removed, whereas solar cheilitis is not.

It cannot be squamous cell carcinoma because it occurs between the vermillion border of the

lips and the hard and soft palate or the posterior one third of the tongue. In this case the lesion

is only located on the outside of the lips. This condition mestastizes to lymph nodes of the neck,

as well as the liver, and lungs. Also, squamous cell carcinoma is typically caused by tobacco,

alcohol, or a combination of both, but we have reason to believe his lesion is caused from long

term sun exposure.

Actinic keratosis is also caused by sun exposure, but the affected areas vary from face, lips,

ears, scalp, shoulders, neck and the back of hands and forearms. This presents as a rough,

itching, scaly patch of skin that can develop very slowly, even up to years. We did not use this

as the diagnosis because this is often described as itching or burning and this patient stated

there was no pain associated with the lesion.

While reviewing our case we noticed that two of the diagnosis were very similar which are

actinic cheilitis, and actinic keratosis. The major difference between these diagnoses, are the

common form of actinic cheilitis is due to chronic sun exposure and is the lip form of actinic

keratosis. Actinic cheilosis also has various names such as, solar cheilitis, and sometimes actinic

cheilitis with histological atypia. While discussing our case as a group this was a key factor that

was taken into consideration to help diagnose our patient.

References:

Oral Pathology for the Dental Hygienist with General Pathology Introductions by Olga A.C. Ibsen

and Joan Anderson Phelan

https://www.healthline.com/health/actinic-cheilitis

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3283947/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4126916/

https://www.merckmanuals.com/professional/ear,-nose,-and-throat-disorders/tumors-of-the-head-

and-neck/oral-squamous-cell-carcinoma

https://emedicine.medscape.com/article/1099775-clinical

https://www.skincancer.org/skin-cancer-information/actinic-keratosis/#what

https://www.medicalnewstoday.com/articles/319133.php4

https://www.webmd.com/skin-problems-and-treatments/understanding-actinic-keratosis-

basics