Actinic cheilitis: histologic study of the entire vermilion and comparison with previous biopsy

BACKGROUND: Actinic cheilitis (AC), is the very superficial, incipient form of actinically induced squamous cell carcinoma of the lower lip. Few studies of actinic cheilitis analyzed the entire lip vermilion searching for microscopic areas of progressing carcinoma. METHODS: Twenty patients with biopsy proved actinic cheilitis presenting with diffuse clinical changes were submitted to vermilionectomy of lower lip. Surgical specimens were sectioned every 3 mm, studied histopathologically and findings were compared with the biopsy. Histological findings were classified as 'AC', carcinoma in situ (CIS), superficially invasive squamous cell carcinoma (SISCC), and invasive squamous cell carcinoma (ISCC). RESULTS: Comparison between biopsies and most severe changes on vermilionectomies revealed coincidental changes in 10 cases (50%), more severe changes on biopsy occurred in two cases (10%) and in eight cases (40%) the changes on vermilionectomy were more severe. SISCC was diagnosed in nine cases (45%): of these, two had been detected on biopsy, six had shown a milder aspect on biopsy, and in one biopsy had shown ISCC. Foci of discontinuous areas of SISCC were detected in four cases (20%). CONCLUSIONS: These findings suggest that cases of AC presenting with poorly demarcated lesions may bear severe histopathological changes irregularly distributed along the vermilion.