Lips

Lips are visible to a dentist and hence surface changes should be easily noted. Changes such as roughness, growths, pigment changes, vascular changes, colour, size and contour are all easily recognised. We will look at the common changes first and then consider some rarer skin diseases that can present with features on the lips.

Lip Swelling

Melkerson Rosenthal syndrome 

Lip Eczema

Lip licking 

Contact dermatitis extending on to surrounding skin

Early irritant lip eczema

Lip Pigmentation

Labial melanotic macule

Dermatoscopic view

Labial pigmentation of Peutz Jeger syndrome with freckles

Elderly male with Peutz Jeger Syndrome

Lip tumours

Large ulcerated Squamous cell carcinoma Check submental and cervical lymph glands

Basal cell carcinoma of upper lip skin
Made more prominent below with lateral pressure

Basal cell circinoma involving the vermillion of the lip

Another large squamous cell carcinoma 

An ulcerated SCC. Feel the lesion itself for underlying induration and thickening

Looks like an SCC but it was a wart

Another aggressive wart on the lower lip
Sometimes oncogenic virus derived meaning
they can develope into SCCs

An eroded SCC in situ with solar cheilitis on the lips
and solar keratoses on the surrounding lip skin

An infiltrating BCC shown by the pale area surrounding the central ulceration.
This lesion requires wide excision to clear it.

This was a pyogenic granuloma, a benign proliferation of blood vessels commonly seen
 after local injury in pregnant women

A neglected invasive SCC. Feel for local gland metastases

In contrast an early ulcerated invasive squamous cell carcinoma.

Lip Ulcers

This is during a course of radiotherapy for an SCC of the lower lip

Lip papules



Lip roughness

Actinic cheilitis with rough keratotic lips and
erosions when the skin is peeled off.

Erythroplakia on the lower lip suggestive of SCC Biopsy required.

Lips perleche (Angular cheilitis)

Lips vesicles

Grouped vesicles of herpes simplex on the lip
and cheek skin

Ulcerated herpes simplex on lips

Herpes simplex superimposed on underlying atopic dermatitis

Lips white material

Extensive candida on lips in Chronic mucocutaneous candidiasis

Less florid candida of the lips. This white material will swab off.

Leukoplakia on the lower lip.
This will not swab off and should be biopsied.

Leukoplakia on the inner upper lip surface. More worrying for early
malignant change and should be biopsied

Lips Other Medical Conditions

Discoid lupus lower lip

Lichen planus of lower lip

Erythema multiforme presenting as ulcersation on the lips
Check the eyes as well as target lesions on hands

This is Sjogrens of the mouth and lip with
associated gingivitis

This red lip was due to a dermatophyte fungal infection
after strong steroid ointment was used on the lip

Lips Unusual

This is a persistent calibre artery on the lip

Secondary infection after Imiquimod was used on a skin cancer above
the lip getting on to the lips and reacting with  solar damage
on the surface!

Early vitiligo with loss of pigment around the vermillion
border of the lips.