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Actinic cheilitis

Synonyms: Cheilitis actinica

By Dr. Pascal Bafteh · last updated 09/2026

Actinic cheilitis: Whitish scaling and blurred vermilion border of the lower lip (photo: Faria, Silva, Mafra et al. (2022), Europe PMC, CC BY 4.0) (Foto: Faria, Silva, Mafra et al. (2022), Wikimedia Commons, CC BY 4.0) — Faria, Silva, Mafra et al. (2022), „Actinic cheilitis in rural workers: prevalence and associated factors", CC BY 4.0, via Wikimedia Commons · CC BY 4.0 · Source

Clinical picture, risk and diagnostic confirmation

Definition: actinic keratosis of the vermilion, almost exclusively of the lower lip as the main sun terrace; clinically a dry, scaling, ill-defined lip with blurring of the vermilion border.
Risk of malignant transformation: Actinic cheilitis progresses to invasive squamous cell carcinoma more often than actinic keratoses elsewhere, and the lip is one of the high-risk sites of cutaneous squamous cell carcinoma.
Biopsy is mandatory with induration, ulceration, nodule formation, persistent leukoplakia or refractoriness to treatment — severe actinic cheilitis cannot be reliably separated clinically from an early invasive carcinoma.
Grading as for actinic keratoses according to Olsen I–III (I more palpable than visible, II clearly visible/rough, III firmly hyperkeratotic). Exam pitfall: even a grade I lesion can progress to squamous cell carcinoma — grading gives no all-clear, and the choice of treatment follows patient-, lesion- and therapy-related factors (S3 guideline), not the grade alone.
Occupational disease: In predominantly outdoor workers consider occupational disease no. 5103 (squamous cell carcinoma or multiple actinic keratoses of the skin caused by natural UV radiation) and check whether a formal report is indicated.
Secondary prophylaxis: consistent sun protection, lip balm with SPF ≥ 30, avoidance of midday sun, smoking cessation; regular checks of the whole field.

Differential diagnoses

Actinic keratosis
Herpes simplex labialis
Psoriasis vulgaris (plaque psoriasis)
Bowen's Disease
Verruca vulgaris
Secondary syphilis (lues II)

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Sources (selection)

AWMF S3 AK 2023

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Note: This page is intended for medical education and does not replace diagnosis or treatment decisions in individual cases. Treatment and follow-up content is available in the app.