Dermoscopic findings of labial keratinocytic tumors: Actinic cheilitis, intraepidermal carcinoma and squamous cell carcinoma dermoscopy

Actinic cheilitis (AC), the most common premalignant lip lesion, is an inflammatory disease caused by sun exposure that affects the lip vermilion. AC is a potentially malignant disorder or an incipient form of carcinoma that may develop into squamous cell carcinoma (SCC) of the lips. The diagnosis of AC is important because the initial clinical manifestations are subtle and do not necessarily reflect the extent of damage to the epithelial and connective tissues. Cutaneous squamous cell carcinoma (SCC) is the second most common cutaneous malignancy after basal cell carcinoma,and typically occurs in older, fair-skinned individuals. In particular, SCC of the lip represents 20% of all oral carcinomas, with the lip being one of the most high-risk anatomical sites. Little is known about dermoscopic features of lip squamous cell carcinomas (SCC) and actinic cheilitis (AC). Identification of the dermoscopic findings of lesions located on the lips are important, since its anatomic and histologic features are unique. Our objective is to describe dermoscopic findings of AC in conjunction with labial SCC and to describe the clinical and demographical features of this patients with keratinocytic labial tumor. A total of 41 patients with histopathologically confirmed labial keratinocytic lesion, 31 AC and 10 SCC, were included in the study. Dermoscopical and clinical features were evaluated. Statistical analysis was performed using SPSS v.21.0. Continuous and categorical data are shown as means ± SD and percentages, respectively. The median age was 66,41 ± 13,35 and the majority were male (76%). More than 90% were located on the lower lip. The most common Fitzpatrick skin type was type III , and the rest was type II. Facial actinic keratoses were found in 35% of the patients with AC. Current or exsmoking was high as 44%, while regular alcohol use was 2% in total. All were outdoor workers, mostly farmers. ACs were flat and yellow-white scally lesions causing ill-defined vermillion border and one-fourth had superficial erosions, crusts, fissures and swelling. In SCCs, vermillon line loss was observed only when it was infiltrated . Most were flat and ulcerated with crusts . All had scales and induration, however induration also detected in 6% AC case. We described two dermoscopic patterns for AC. SCCs revealed the pattern of central scale, crust and ulceration surrounded by radially distrubuted polymorphous vessels.As a result of this study, two actinic cheilitis patterns, which were not previously described in the literature, have been described. Radial hairpin vessels have been proposed to be named as "magnet sign" due to the similarity of magnetic wave distribution to the center. To our knowledge, this is the first descriptive dermoscopic study of the actinic cheilitis. Our study demonstrates the specific clinical and dermoscopic features of AC that differ from SCC will guide clinicians to perform biopsy.The white structures in the vascular periphery related to the tumor keratinization around the vessel histologically, which previosly referred to as perivascular white "halo" in the literature [169], have been observed in SHK at similar ratesin our study too, but "perivascular white sheath " is suggested to be more accurate than "halo" as the name for this finding. To our knowledge, this is the first descriptive dermoscopic study of the actinic cheilitis . Our study demonstrates the specific clinical and dermoscopic features of AC that differ from SCC will guide clinicians to perform biopsy.