What is Actinic Cheilitis (Sailor’s Lip)?
“Sailor’s Lip,” also known as actinic cheilitis (AC), is a condition that can potentially lead to a type of skin cancer called squamous cell carcinoma (SCC) found on the lips. Actinic cheilitis is similar to a condition called actinic keratosis, and both are caused by prolonged exposure to the sun. Actinic cheilitis is most common on the bottom lip along the line where the lip color meets the skin. It’s crucial to recognize this condition early because lip skin cancer is considered a high-risk form and has an 11% chance of spreading to other parts of the body compared to only 1% for skin cancer in other body locations. Therefore, proper identification and management of these potentially harmful precursor conditions like actinic cheilitis is important.
What Causes Actinic Cheilitis (Sailor’s Lip)?
Actinic cheilitis is a condition caused by exposure to the sun or ultraviolet (UV) rays. Other factors that can increase the risk of developing this ailment include being over 60 years old, having Type I or II fair skin, genetic conditions that impact skin color such as albinism, working outdoors for more than 25 years, or a having history of nonmelanoma skin cancer (NMSC). It’s still unclear whether alcohol use and smoking can directly increase your risk of getting actinic cheilitis.
Risk Factors and Frequency for Actinic Cheilitis (Sailor’s Lip)
Actinic cheilitis, a condition affecting the lips, is more common amongst people with fair skin and those who live near the equator where the sun’s UV rays are stronger. Men tend to get it more than women, probably because they often work more in the sun and use less lip balm or make-up to protect their lips. However, the exact number of people with actinic cheilitis is not known as most studies focus on the occurrence of a type of lip cancer called SCC. In the United States, there are over 3500 new cases of lip cancer each year, 90% of which are SCC. A study also found that in northwestern Spain, 31.3% of people over 45 had actinic cheilitis.
Signs and Symptoms of Actinic Cheilitis (Sailor’s Lip)
There’s a condition where a person might have a persistent white plaque, or patch, on their lips that feels rough, similar to sandpaper. This most commonly affects the lower lip. Over time, the clear line where the skin of the lip meets the inner, moist part of the lip may become blurred. Generally, people don’t feel any discomfort from it, but some may experience symptoms such as a burning sensation, numbness, or pain.
As the condition progresses, the plaque may harden, become scaly, and develop ulcers. Certain groups of people, including outdoor workers like sailors, farmers, construction workers, and lifeguards, are more susceptible to this condition, as are people with fair skin (known medically as Fitzpatrick I-II).
- Persistent white plaque on lips feels like sandpaper
- Most commonly found on the lower lip
- Blurry line between the outer and inner lip
- Usually doesn’t cause discomfort, but can sometimes cause burning, numbness, or pain
- Plaque may harden, turn scaly, and develop sores over time
- Outdoor laborers and fair-skinned individuals may be more susceptible
Testing for Actinic Cheilitis (Sailor’s Lip)
Actinic cheilitis is a condition often diagnosed based on a combination of medical examination and tissue analysis. It’s important to differentiate between this condition, simple skin inflammation (known as cheilitis), and a type of skin cancer called squamous cell carcinoma. If you have a persistent, suspicious-looking spot on your lip, a skin biopsy is often the best way to identify the issue.
Interestingly, many spots thought to be actinic cheilitis turned out to be squamous cell carcinoma after tissue analysis. This shows that doctors can’t always rely solely on their initial examination, and suggests that biopsy is a useful step when dealing with these kinds of skin abnormalities.
While not a necessary step in making a diagnosis, some experts argue that using a tool called electron microscopy can provide even more in-depth information about the structure of skin lesions. It helps to gauge their potential to become malignant and could support their accurate diagnosis and treatment.
At the physical exam, doctors will look for persistent white or reddish thick, rough-textured skin on the lower lip. They will also ask for some lab tests for people with new lesions, particularly for those who are younger, have darker skin types, or don’t have a history of long-term sun exposure, as these factors might make skin cancer less probable. These tests could help rule out causes that can be reversed, such as certain vitamin deficiencies or irritations from external factors.
If the skin lesion persists, a skin biopsy will be recommended. This test involves taking a small sample of skin for examination under a microscope. The electron microscopy, will reveal specific signs such as thickened skin (hyperkeratosis), slightly thickened layers of skin (mild acanthosis), and a build-up of specific white blood cells (lymphocytes) around tiny tube-like structures in the skin (glandular ducts).
Treatment Options for Actinic Cheilitis (Sailor’s Lip)
Treatment for actinic cheilitis, which is a precursor to a type of skin cancer, varies based on a few factors. These include the size, location, and harshness of the lesion, as well as any other underlying patient health conditions. The aim of treatment is to prevent the condition from becoming skin cancer, while keeping the lips functional and looking normal. There are several ways to manage this condition, including both surgical interventions and medical treatments.
Surgical treatments can involve procedures like vermilionectomy, cryotherapy, electrocautery, and various forms of laser treatment. But these are invasive and can cause side effects such as pain, delayed healing, infection, scarring, swelling, and altered sensations.
Non-surgical treatments are also available and include topical therapies such as 5-fluorouracil, imiquimod, and others. These treatments also can cause adverse effects like inflammation, skin crustiness, and pain which might deter patients from sticking to the treatment.
A study reviewing 283 patients found that surgical treatments had a higher success rate (92.8% vs. 65%) and lower recurrence rates (8.4 vs. 19.2%) compared to non-surgical treatments. Dermoscopy, which is a method of looking at the skin closely, can assist in diagnosis and monitoring treatment progress in patients getting topical treatment.
However, it’s challenging to compare the effectiveness of the many treatment options due to inconsistency in research study designs and patient populations.
Here’s a summary of the treatment options:
1. Laser treatment: This non-surgical intervention is favored (93% effective, few recurrences), but can cause pain and excessive scarring which might be managed with corticosteroids.
2. Vermilionectomy/Surgical excision: This is the preferred treatment for severe cases (almost 100% effective, few recurrences), but it could potentially cause negative cosmetic outcomes compared to other treatment options.
3. Topical treatments: These are recommended for patients with large areas of sun damage or those who prefer a non-surgical approach.
Phototherapy is another method which, interestingly, uses high-intensity light to damage damaged skin cells and has been found to be somewhat effective (68% effective, 12% recurrences).
Other options include cryotherapy, which uses liquid nitrogen to physically destroy abnormal cells, and electrocautery or curettage, which also physically destroys these cells.
Photoprotection involves reducing exposure to sun and is dependent on the patient’s cooperation.
What else can Actinic Cheilitis (Sailor’s Lip) be?
When a doctor examines a sore on your lip, they will consider several possibilities. These could include skin cancers such as squamous cell carcinoma, basal cell carcinoma, and malignant melanoma. They’ll also consider conditions like herpes, leukoplakia, and various types of cheilitis.
Cheilitis, which is a term for inflamed lips, can have many causes. These could be factors that can be reversed, conditions that cannot be reversed, and causes related to overall body health.
It’s important for the doctor to find out what’s causing a lip lesion because some of these conditions can be serious. If a lip sore doesn’t improve with treatment, the doctor may need to take a small sample of skin (a biopsy) to help identify the cause.
What to expect with Actinic Cheilitis (Sailor’s Lip)
Actinic cheilitis is a condition that can turn into a more serious disease called SCC in about 6 to 10% of cases. People with actinic cheilitis should have regular check-ups following treatment. They should see their doctor at least every six months for the first two years, and once a year for skin checks after that.
Possible Complications When Diagnosed with Actinic Cheilitis (Sailor’s Lip)
About 95% of Squamous Cell Carcinoma (SCC), a type of skin cancer, on the lip begins as actinic cheilitis, a lip inflammation caused by sun damage. It’s important to note that SCC on the lip is far more dangerous than SCC on other parts of the body. Studies show that 11% of SCC lip cancer spreads to other parts of the body, whereas only 1% of SCC found in other locations does the same.
Preventing Actinic Cheilitis (Sailor’s Lip)
Patients can lessen their chances of developing actinic cheilitis and its possible progression into SCC (a type of skin cancer) by employing several protective measures:
* Using sunscreen and UV-protective clothing
* Wearing wide-brimmed hats
* Applying lip balms or makeup that contains sunscreen/zinc
* Regularly checking the skin and scheduling follow-up appointments
These precautions can help shield the skin from harmful ultraviolet rays, thereby reducing the risk of skin disorders and complications.
