Actinic cheilitis is a type of precancerous skin condition that affects the lips. It is usually related to damage from sun exposure or tanning beds. If left untreated, this condition can turn into a kind of skin cancer called squamous cell carcinoma.
Learn more about actinic cheilitis and how to treat and prevent it.
What Are the Symptoms of Actinic Cheilitis?
Also called sailor’s lip, farmer’s lip, or solar cheilosis, actinic cheilitis is a skin condition affecting your lips. It’s a form of actinic keratosis, which is a precancerous skin growth. All types of actinic keratosis have the same underlying cause — long-term UV light exposure that damages skin cells.
Actinic cheilitis usually isn’t painful, but it may be uncomfortable. Some signs of actinic cheilitis include:
- Lips that always feel chapped
- Tightness of the skin of your lips
- Rough texture of your lips
- Cracked skin on your lips
- A dry, flaky appearance of the skin on your lips
- A change in lip color, making them look more like the surrounding skin
Some people with actinic cheilitis notice changes to large areas of their lips, while others may have only a single spot that looks different from the surrounding skin.
Symptoms based on actinic cheilitis stages
In its early stages, actinic cheilitis may make it seem like your lips are simply chapped. But then, you might notice, “this has been going on for months, and no matter how much lip balm I put on or how much I stay hydrated, it’s not going away,” says Veena Vanchinathan, MD, FAAD, a board-certified dermatologist in California’s Bay Area.
Also, the line between your lips and the surrounding skin, called the vermilion border, may become blurred or wrinkled.
In the later stages of actinic cheilitis, your lips might become rough, scaly, and cracked. You might notice “more prominent visual changes to the lips. It might look more obvious that the surface area of those affected areas of the lips looks different. It might be white or really, really scaly compared to the normal areas of the lips,” Vanchinathan says.
You might also experience pain or bleeding in the more advanced stages of actinic cheilitis, she says. However, she adds, “I tend to find that in general, it progresses fairly asymptomatically, and I think that’s why it’s underrecognized.”
What Causes Actinic Cheilitis?
Actinic keratosis is caused by damage from ultraviolet (UV) light. This is usually due to sun exposure. Using tanning beds or sunlamps can also damage your skin. Severe damage from UV light can change the skin cells known as keratinocytes, causing changes in texture and color over time.
Your lips are more vulnerable to UV light rays than the rest of your skin is. That’s because the skin on your lips is thinner and contains less pigment, which helps protect your skin.
Your lower lip is more likely to be affected than your upper lip. “The lower lips tend to be more prominently affected due to the way that the sun reflects on our lips and our skin,” Vanchinathan says.
Risk factors for actinic cheilitis
Some people may be at a higher risk for actinic keratoses. Your risk may be higher if you have any of these factors:
- Fair skin that sunburns easily
- Albinism
- Naturally light-colored hair, such as red or blonde
- Light-colored eyes
- Age 50 years or older
- Being an organ transplant recipient
- Taking medication that makes you more sensitive to sunlight
- Having certain immune system disorders
- Not using sun protection
- A history of nonmelanoma skin cancer
- Working outdoors for 25 years or longer
Men are more likely to have actinic cheilitis because they are more likely to be outdoor laborers and less likely to use lip balm with sun protection. People who live closer to the equator or at higher altitudes are also more likely to get actinic cheilitis because UV rays are more intense there.
Not many people are aware that actinic cheilitis exists, Vanchinathan says. “A lot of us are aware that with sun exposure, our skin gets damaged, but not a lot of folks are aware that mucosal surfaces, such as the lips, can actually develop precancerous or even cancerous conditions.”
Can Actinic Cheilitis Cause Skin Cancer?
If left untreated, actinic keratosis and actinic cheilitis can develop into a type of skin cancer called squamous cell carcinoma. It is a treatable form of cancer with a low risk of death. But if it’s not treated, it can cause damage to the skin, nerves, and blood vessels.
About 10%-30% of actinic cheilitis cases may progress to invasive squamous cell carcinoma. And most cases (up to 95%) of squamous cell carcinoma start out as actinic cheilitis.
Actinic cheilitis is more likely to develop into squamous cell carcinoma compared to other forms of actinic keratosis. So, actinic cheilitis on your lips is more likely to develop into skin cancer than the same type of condition on your hand or leg, Vanchinathan says.
A squamous cell carcinoma on your lips could also cause permanent disfigurement. Treatment can involve removing sections of skin to get rid of cancerous cells. Talking and swallowing may be more difficult if the cancer damages nerves around your mouth.
Also, actinic cheilitis is much more likely to spread to other areas, like the lymph nodes, compared to squamous cell carcinoma in other areas. Actinic cheilitis has an 11% chance of spreading, while squamous cell carcinoma in other areas of the body has a 1% chance.
How Is Actinic Cheilitis Diagnosed?
To diagnose actinic cheilitis, your doctor will do a physical exam and ask you about your medical history and habits.
Your doctor will examine your lips to see if you have actinic cheilitis, cheilitis (a benign type of inflammation), or more advanced squamous cell carcinoma.
During an exam, Vanchinathan says, “The first thing that I do is I actually palpate or touch the area — with gloves, of course — but you can still feel, it’s almost like a sandpaper-like texture for actinic cheilitis, compared to ‘normal’ chapped lips or regular skin.”
Next, Vanchinathan uses a tool called a dermatoscope, which is like a handheld magnifying glass/microscope, to zoom in on the skin. With the dermatoscope, she says, “I typically see those subtle, light, scaly patches. And I can often see where the normal skin is ending and where the damaged area is beginning.”
Your doctor may ask you about:
- How much time you spend in the sun
- Whether you work outdoors
- How much you use sun protection, including on your lips
- If you have a history of cancer
Your doctor may order a skin biopsy, which removes part of the affected skin so that it can be analyzed in a lab. “A biopsy is not typically done if there’s a strong clinical suspicion for actinic cheilitis, which would be a combination of the history that the patient’s providing us, as well as the exam itself that the physician is performing,” Vanchinathan says.
“If we're on the fence about: Is this actinic cheilitis or squamous cell carcinoma? We might take a small biopsy of the lip to help illuminate the diagnosis for us,” Vanchinathan says.
Treatment for Actinic Cheilitis
If you have actinic cheilitis, doctors can remove or destroy the damaged skin cells with minimally invasive procedures. Most of them can happen in a doctor’s office. Some methods require more than one visit and repeated treatments.
Topical treatments. With this treatment, you apply prescription creams to your skin that destroy the damaged cells. These include 5-fluorouracil and imiquimod. Typically, you put a thin layer of this medication on your lips once or twice a day for at least two weeks, Vanchinathan says.
Laser resurfacing. Medical-grade lasers are used to remove very precise areas of skin. The doctor can control how deep the laser reaches into your skin and precisely target the actinic cheilitis. Your treated skin may be raw until new, healthier skin appears.
Cryosurgery: This is sometimes called freezing. Cryosurgery is a common technique for removing skin blemishes such as warts. Your doctor will apply a freezing substance, such as liquid nitrogen, to the actinic cheilitis. The lesion will later blister and flake or peel away. You may need more than one treatment to remove all the layers.
Chemical peel. Your doctor will use a high-strength chemical solution to destroy the top layers of the skin where you have actinic cheilitis. This chemical peel is more intense than the version you might get for cosmetic purposes. Over-the-counter chemical exfoliants will not remove actinic cheilitis.
Curettage. It is a procedure to scrape and cut away the damaged area of your skin. Doctors use this if they think the actinic cheilitis is particularly deep. After curettage, your doctor may also do electrosurgery, which uses an electric current to destroy the damaged cells.
Photodynamic therapy. With this treatment, your doctor applies a solution to the area that makes it sensitive to light. You sit in the office with the solution on for about 60-90 minutes, and then your doctor uses light to activate the solution and destroy the actinic cheilitis. This usually requires two treatments.
Vermilionectomy. This treatment is a surgery that removes all or part of your vermilion border, where the edge of your lip meets the surrounding skin. This treatment is usually done in severe cases of actinic cheilitis.
The best treatment option for you will depend on your circumstances, including how severe your actinic cheilitis is.
Generally, Vanchinathan says that in her clinical experience, liquid nitrogen or cryotherapy is the most common initial treatment option. “Liquid nitrogen works very, very well for both actinic cheilitis and actinic keratosis,” she says. However, she has found that “actinic cheilitis is a little bit more aggressive compared to similar precancerous changes in the skin,” so it may take another session with liquid nitrogen to treat the actinic cheilitis.
Topical treatments are the next most common treatment option, but they take longer, and “patients often have more prominent side effects, so a lot more redness, peeling, blistering than they might with liquid nitrogen,” Vanchinathan says.
Preventing Actinic Cheilitis
The best way to prevent any damage from UV rays is to protect yourself from the sun. Avoid using tanning beds or tanning lights. You can get a spray tan for an attractive glow without the risk of skin damage.
“Avoiding any intentional, extra UV exposure is really critical for protecting our skin’s health and our lips’ health long term. So, for example, avoiding tanning beds, intentionally trying to get a base tan, things like that can go a really long way at guarding our health in the future,” Vanchinathan says.
You can protect your face when you are outdoors by wearing a hat with a wide brim. Stay in the shade when you can. Use sunscreen and reapply it often when you are exposed to sunlight. Look for lip balms with sunscreen to protect your lips from actinic cheilitis.
Vanchinathan recommends using lip balm with SPF every day, regardless of the weather and your skin tone. “Reapply at least every two hours, or more frequently if you’re outside sweating or swimming,” she suggests.
“Regular lip balm that does not have SPF provides zero protection against UV rays, and if we’re using a very shiny lip balm, that might actually even increase our risk for UV damage” because of how it reflects, Vanchinathan says.
Contact your doctor if you are concerned that you have actinic cheilitis or any sort of actinic keratosis.
Takeaways
Actinic cheilitis is a form of actinic keratosis, a precancerous skin condition, that appears on your lips. Because actinic cheilitis can progress into skin cancer and spread to other areas of the body, it’s important to get it treated. Several treatment options can remove or destroy the damaged skin cells. Even if you’re careful about wearing sunscreen while outdoors, you might forget to protect your lips. It’s a good idea to wear lip balm with SPF every day to prevent actinic cheilitis and skin cancer on your lips.
Actinic Cheilitis FAQs
Does actinic cheilitis go away on its own?
It’s unlikely for actinic cheilitis to go away on its own without treatment. Because there’s a risk that it will turn into squamous cell carcinoma, it’s important to get treated.
How do I know if I have actinic cheilitis?
Actinic cheilitis may feel like chapped lips in the beginning. If you’re having symptoms, you should see your doctor to find out whether you have actinic cheilitis.
How long does actinic cheilitis last?
Treatment can destroy the abnormal cells on your lip from actinic cheilitis. Different treatments have different durations, so how long actinic cheilitis lasts will depend on the specific treatment you are getting.
How can I treat actinic cheilitis at home?
It’s important to get treated by a doctor if you have actinic cheilitis, as the best treatment for you depends on your specific situation. Some topical creams can treat actinic cheilitis, but you need a prescription for them.
