Paying lip service

Sun damage to the lower lip is becoming a major problem in the elderly. In this patient there is a marked difference between the condition of the vermilion surfaces of the upper and lower lip. There are both ulcerated and hyperkeratotic areas on the lower lip, each of which require a biopsy to see the nature and extent of the solar-induced damage. 

Induration of the ulcerated area would make invasive SCC highly likely. All areas of leukoplakia on the lower lip should be biopsied but not all areas signify malignancy. Sometimes a condition such as discoid lupus erythematosus will present like this man’s lower lip but biopsy will distinguish it from an SCC. 

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