word

1. Actinic chelitis
Also called actinic keratosis & solar cheliosis .
Difinition : condition of the tissue odegenerativef the lips after
years of exposure to ultraviolet (UV, mainly UVB) light, such as
sunlight. It is a premalignant condition.
Etiology
chronic and excessive exposure to ultraviolet radiation in sun
light including :
- Hot and dry region .
- outdoor life style (farmers,sailors) so called farmers and
sailors lip .
- individuals with lighter skin tone than blacks as blacks
have protective effect of melanin .
- Genetic disorder ex:- albinism , xeroderma pigmentosum
Clinical features
Age : older individuals, and rarely those under the age of 45 year
may due to chronic exposure to sun light .
Race : less common in blacks (due to melanin ).
Sex : stronge male predilection due to more outdoor occupational
activity and less frequent use of lip protective agent (sun screen
effect of lip sticks ) compared to women .
Site : almost always affects the lower lip as it is more prominent
therefore it receives more solar radiation than upper lip .
s&s : usually painless and develops so slowly , at first , redness and
edema may occur with blurring of margin between virmilion
and skin but later on, dry , fissured and scaly lip appears ,
tinny bleeding points revealed with removal of scales .
with passage of time , these scales become thick and horny
with distinct edge . epithelium bcomes palpably thickened
with small grayish white plaque . vertical fissuring and
crusting occur especially in cold wether .

2. The possibility of malignancy must always
be considered if following features are present;
, a red and whiteUlceration in actinic cheilitis
blotchy appearance with an indistinct vermilion
border, generalized atrophy or focal areas of
whitish thickening, persistent flaking and crusting
and indurations at the base of keratotic
lesion.
D.D : must be differentiated from habitual lip bitting and
tobacco irritants ( biopsy is indicated ) .
Histopathological Features
- Solar cheilitis reflects a spectrum of microscopic
changes similar to leukoplakia.
- early limited changes are restricted to the
keratin layer, which manifests thickening,
- and the subjacent connective tissue zones,
which characteristically show clumping,
fragmentation, and granulation of elastic
fibers known as solar or senile elastosis.
Progression to cytologic atypia, dysplasia,-
sive carcinoma can developand frank inva
in actinic cheilitis.
The earliest premalignant atypicality is represented by
atrophy
of the spinous cell layer, fragmentation of
the basement membrane, and mild hyperchromatism
and/or pleomorphism of the
.basal cells
Types of dysplasia in A.CH ( miald ; basal &parabasal -
moderate; to midle - severe more than midle ) , so biopsy
should be taken to determine whether or not dysplasia is
present .

3. Prognosis & treatment
- This condition is considered premalignant because it may lead
to squamous cell carcinoma in about 10% of all cases.
- Treatment of actinic cheilitis is required to relieve symptoms
and to prevent development of SCC .
- The main AC therapies aim to remove or destroy the
abnormal epithelium for example vermillionectomy (treatment
of choice) The advantage of this technique is that it provides
tissue for histopathologic examination
& carbon dioxide laser ablation .
- long term follow up is recommended as it takes several time
to transform into malignant .
- clearing of lesions noted within 4 weeks of treatment
completion .