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Lips will tell the truth-

Diseases of the Lips in 16 diagrams

Dr Sampurna Roy MD                 


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To understand the lesions of the lips we must first understand its normal anatomy.

A) Normal Anatomy

Lips include vermillion borders

1. Upper vermillion border

2. Lower vermillion border ). The vermilion borderas also known as the "lipstick region" is the region between the labial mucosa and the skin.

 These are joined at the 3. commissures of the mouth.

4. Philtrum is the groove located just above the upper lip which extends to the nose.

Pathological lesions in this region may originate from structures in the skin and the mucosa.

B) Congenital Abnormalities:

 1)  2)



Failure of coalescence of the developing processes results in either

1. a partial cleft lip ,

2.  Complete cleft of lip and alveolus or 

3.  Double cleft of the lip and alveolus. 

Possible causative factors: 

Exposure to x-ray, cortisone intoxication, vitamin deficiency and certain virus infections (Example:Rubella) during the first trimester of pregnancy, are all associated with an increased incidence of these abnormalities in the fetus.

C) Non Neoplastic Lesions of Lips


Pigmented Lips-

Brown pigmented spots on the lips occur in familial intestinal polyposis (Peutz-Jeghers syndrome.

Addison's disease must be excluded.

Fordyce's Spots -  These may be present along vermillion border of the lips or on the oral mucosa.

Visit: Fordyce's Spots


Cracked Lips-  Chapping is common and a definite crack in the middle of the lower lip, which bleeds readily is a frequent complaint in cold weather.



Infection - Angular Cheilitis  (Syn: Angular Stomatitis) - There are moist, infected and crusting cracks at the angle of the mouth.

The cause is a leak of saliva at the corners of the mouth and the moist skin becomes infected by candida and staphylococci.

In mucocutaneous Candidosis (Candidiasis) patients suffer from infection of skin and mucous membrane of the mouth including lips.



Angular Cheilitis is also noted in HIV infected, drug dependant patients.

In HIV positive patients prominent plaques are noted with diffuse erythema at the angle of the mouth.



Nearly 70% Extragenital Chancres (Syphilis caused by the spirochete Treponema pallidum) are located in the mouth.

Lips are most commonly affected.

Syphilitic chancre on the lip present as painless, indurated, ulcerated lesions with associated lymphadenopathy.



Herpes Simplex Virus Infection /Herpes labialis is a common condition characterized by recurrent vesicular eruptions primarily on the lips and perioral skin.

It appears in response to cold winds, bright sunlight, or febrile illnesses, due to reactivation of the virus.



Mucocele or mucous cysts are more commonly located on the lower lip.

 These are noted in younger patients.

Extravasation mucocele represents an area of stromal reaction to spillage of mucus from traumatically injured minor salivary glands.

Microscopically, there is granulation tissue formation around the mucinous space.


D) Granulomatous Lesions of Lips


1) Crohn's disease can involve lips. Clinically, the lesion may present ulcerated, polypoid or papular lesion.

2) Lower lip is usually involved in sarcoidosis. (Visit-Cutaneous Sarcoidosis)

3) Melkersson Rosenthal Syndome is characterized by orofacial swelling, facial nerve paralysis and plicated tongue. (Visit-Melkersson Rosenthal Syndrome)


E) Benign lesions of the Lips:

Lymphangioma and cavernous hemangioma are benign tumours located on the lips.

F) Premalignant lesion of the Lips

Actinic cheilitis (Solar cheilosis) is a common condition caused by damage to the lips through exposure to sunlight, and is readily diagnosed clinically.

It is the counterpart of actinic keratosis of the skin and can develop into squamous cell carcinoma. Clinically, the patients often present  with multifocal lesions.

The following manifestations are seen - dryness, atrophy, scaly lesions, swelling of the lip, erythema, ulceration, blurred demarcation between the lip vermilion border and the skin, marked folds along the lip vermilion, white spots or plaques, crusts, blotchy areas, and areas of pallor.

Keratosis, granulosis, hyperplasia, acanthosis, or atrophy and dysplasia are also found in the epithelial tissue. 

G)  Malignant lesions of the Lips

1) Squamous cell carcinoma of the lower lip is a deadly nonmelanoma skin cancer.

The main risk factors involved are cumulative lifetime exposure to sunlight and the use of tobacco.

Lip squamous cell carcinoma is one of the most common malignancies of the oral cavity and is much more likely to metastasize from the lip than cutaneous surfaces.

2) Basal-cell carcinoma mostly occurs in patients of advanced age, between the 5th and the 7th decades of life.

These lesions are usually located on the vermilion border of the upper and lower lips.


These hand drawn diagrams demonstrate that one of the most beautiful part of our body can be destroyed by a wide range of diseases.


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Dr  Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)








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