The most common skin cancer of the cutaneous and mucosal lip is basal cell carcinoma, found most often on the glabrous surface of the upper cutaneous lip of women. However, organ transplant recipients (OTRs) are at increased risk of developing squamous cell carcinoma (SCC) of the lower lip, which is frequently preceded by severe actinic damage. This chapter focuses on the diagnosis and treatment of actinic cheilitis and SCC of the lower lip vermilion in this high-risk patient population.

CLINICAL PRESENTATION

Actinic cheilitis is a premalignant condition of the vermilion of the lower lip, which is analogous to actinic keratosis arising on glabrous skin (Figure 36.1). Major risk factors for actinic cheilitis and SCC of the lip include exposure to ultraviolet radiation, fair skin, smoking, male gender, age over 50, family history of skin cancer, and human papillomavirus (HPV) infection. Actinic cheilitis presents as scaling or dryness of the lower vermilion, within which more distinct erythematous, keratotic, or erosive lesions can develop. Malignant transformation of actinic cheilitis occurs in 10–20% of the general population, with higher transformation rates expected in OTRs. SCC in situ and invasive SCC present clinically in a continuum from solitary, sharply demarcated, red, scaly plaques to ulcerated bleeding nodules (Figure 36.2).

Verrucous carcinoma of the lip, or oral florid papillomatosis, is a slow-growing low-grade SCC that rarely metastasizes. Often resembling a wart, it may be soft with multiple sinuses opening to the skin surface.