Actinic cheilitis — ORE Part 1 MCQ

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HardOral Medicine and Oral PathologyActinic cheilitisORE Part 1

A 66-year-old retired builder has chronic scaling, blurring of the vermilion border and mixed white-red change affecting the lower lip. He has extensive lifetime sun exposure. Over the last 2 months, one area has become focally indurated. What is the most likely diagnosis?

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Correct answer: A — Actinic cheilitis with malignant change

Explanation lettering: C = shown as B · E = shown as C · B = shown as E

A is correct. Actinic cheilitis typically affects the chronically sun-exposed lower-lip vermilion in older people and causes persistent dryness/scaling, white-red change and loss of definition of the vermilion border. New focal induration is a red flag for invasive squamous cell carcinoma developing within actinic cheilitis; definitive assessment requires urgent specialist review and biopsy. Angular cheilitis principally involves the oral commissures. Recurrent herpes labialis is episodic and vesicular before crusting, rather than a persistent diffuse vermilion disorder. Fordyce glands are asymptomatic yellow-white papules without induration. Oral hairy leukoplakia is a corrugated white lesion, usually on the lateral tongue in immunosuppression, not the lower lip.

Reference: Lopes MLDS, et al. Clinicopathological Analysis of Actinic Cheilitis: A Systematic Review with Meta-analyses. 2023. https://pubmed.ncbi.nlm.nih.gov/36892803/