Lower Lip Vermilionectomy for Actinic Cheilitis /Leukoplakia

Actinic cheilitis and leukoplakia are pre-malignant conditions significant for the potential development into an invasive squamous cell carcinoma. This unique condition may be localized or involve the whole vermilion (lipstick zone) of the lower lip.

These two pre-cancerous conditions occur most often in fair skinned men who are exposed to sunlight over a period of many years. Treatment deserves special attention because once the squamous cell carcinoma develops the potential for spread is greater than on regular skin. Invasion into surrounding tissue occur in approximately 10% of patients.

Treatment options:
1) For localized areas of leukoplakia and actinic cheilitis the treatment is very straight forward, using liquid nitrogen with a jet technique. Topical 5% F.U. (5-Fluorouracil) or localized CO₂ laser therapy can also be effective.
2) Therapy of extensive lower lip leukoplakia and actinic cheilitis is more challenging. Past treatments have included cryosurgery, electrocautery, 5 F.U., carbon dioxide laser and scalpel vermilionectomy. All of the treatments with the exception of chemical peeling have a low clinical failure rate. The newer CO₂ lasers including the UltraPulse Encore laser system is an excellent option because the edges can be feathered and blended and the exact lip line can be re-drawn.

CO₂ Laser Vermilionectomy approach: The lower lip is pretreated with a dental anesthetic block which makes this a pain free treatment. The laser is used in low energy levels in a controlled pattern to lightly vaporize the vermilion where the offending cheilitis is located. Healing occurs without scarring, the cosmetic appearance is excellent and recurrences are low. Patients are required to be sun smart and use protective sunscreen 365 days of the year to decrease recurrence rates.