Actinic Cheilitis - do I need a biopsy, and should I be seeing a Oral/Orthodontics or Dermatology?

ANy help gratefully received! 9 months ago i suddenly had tingling on my chin and lower lip, and inside the lip swelled and became very tender. I thought I had cold sores coming, but no, and it continued like this for over a week. Went to GP, he gave me Aciclovir for 5 days, did not help. Swelling gradually subsided but lower lip developed pale patches, with skin flaking off daily. Two months later my dentist referred me to Oral and Orthodontics.

Saw consultant in Jan this year, he took a quick look and said it was sun damage, and I should use sunscreen. I asked if it was Actinic Cheilitis (as I had found out by then), which could be pre-cancerous. He said yes, and did I want a biopsy? I was taken aback and asked if I needed one. He said it was up to me, and would not say whether I did or didn't need one. I said I would have to think about it.

After a bit more research I decided to ask for a biopsy appointment, and turned up to find the same doctor. He seemed surprised and said I could have the biopsy if I wanted, but it could make things worse. I asked again if he thought it necessary or not, but he said it was up to me, and he didn't see any cause for concern. So I didn't have the biopsy.

The swelling, tenderness and pain inside the lip has flared up twice since, with tingling but no cold sores (but small blisters inside lip)

So, can I ask, is it usual to have a biopsy? I also expected some form of treatment to be offered, as per the NHS/Skin Cancer Org websites say. 

I also think I should be seeing a dermatologist too,as the condition is both on the inside and outside of my mouth. Any advice please? I feel this Dr is not sufficiently helpful in my case.

  • Hi Bluebrit and thank you for your post.

    I am so sorry to hear about your situation, this must be such a confusing time for you.

    Actinic Cheilitis  (A form of Actinic Keratoses) is often diagnosed just by looking at the lip, as it is usually caused by sun damage. Not everyone needs a biopsy. A biopsy is usually only done if the doctor is worried about what they see.

    Not all actinic keratoses require treatment and can improve on their own, but It is always best to monitor these lesions as a small percentage can turn into skin cancer such as squamous cell carcinoma.

    If treatment is needed, there are different options, and a hospital specialist can help choose what is best for you.

    This lip condition is more unusual in the UK, Actinic Keratoses is more common, so a lot of the information you find may be from overseas sites.

    The British Association of Dermatologists has written guidelines on the management of actinic keratoses which you may find interesting.

    If you are still worried, it’s okay to ask your GP to refer you to a dermatologist. If one GP says no, you can ask to see another GP in the same practice for a second opinion.

    I hope you find this information helpful.

    Please get back to us if you need any more information or support

    It might help to talk things through with one of our nurses on the helpline. You can call for free on 0808 800 4040, Monday to Friday, 9am to 5pm.

    Kind regards

    Tina

  • Thank you Tina, I have looked at the link which is helpful, and it would seem in my case to be in the 'Mild' category. However, as it is both inside and outside my mouth, and I cannot find any similar cases in my research, this is what is concerning me - is it the outside causing the inside symptoms, or the other way round? Is it usual or common for AC on the lower lip to also affect the inside of the lip?