Erbium Laser Resurfacing for Actinic Cheilitis

November 2013 | Volume 12 | Issue 11 | Case Reports | 1290 | Copyright © November 2013

Joel L. Cohen MD

AboutSkin Dermatology and DermSurgery, Englewood, CO

Abstract
Actinic cheilitis is a precancerous condition characterized by grayish-whitish area(s) of discoloration on the mucosal lip, often blunting the demarcation between mucosa and cutaneous lip.1 Actinic cheilitis is considered to be an early part of the spectrum of squamous cell carcinoma. Squamous cell carcinoma specifically of the lip has a high rate of recurrence and metastasis through the oral cavity leading to a poor overall survival.1 Risk factors for the development of actinic cheilitis include chronic solar irradiation, increasing age, male gender, light skin complexion, immunosuppression, and possibly tobacco and alcohol consumption.1 Treatment options include topical pharmacotherapy (eg, fluorouracil, imiquimod) or procedural interventions (eg, cryotherapy, electrosurgery, surgical vermillionectomy, laser resurfacing), each with their known advantages and disadvantages.2 There is little consensus as to which treatment options offer the most clinical utility given the paucity of comparative clinical data. In my practice, laser resurfacing has become an important tool for the treatment of actinic cheilitis owing to its ease of use and overall safety, tolerability, and cosmetic acceptability. Herein the use of erbium laser resurfacing is described for three actinic cheilitis presentations for which I find it particularly useful: clinically prominent actinic cheilitis, biopsy-proven actinic cheilitis, and treatment of the entire lip following complete tumor excision of squamous cell carcinoma. All patients were treated with a 2940-nm erbium laser (Sciton Profile™ Contour Tunable Resurfacing Laser [TRL™], Sciton, Inc., Palo Alto, CA).

J Drugs Dermatol. 2013;12(11):1290-1292.

INTRODUCTION

Actinic cheilitis (AC; also referred to as solar cheilosis) is a precancerous condition characterized by grayishwhitish area(s) of discoloration on the mucosal lip, often blunting the demarcation between mucosa and cutaneous lip.1 AC is considered to be an early part of the spectrum of squamous cell carcinoma (SCC). SCC specifically of the lip has a high rate of recurrence and metastasis through the oral cavity leading to a poor overall survival.1 Risk factors for the development of AC include chronic solar irradiation, increasing age, male gender, light skin complexion, immunosuppression, and possibly tobacco and alcohol consumption.1 Treatment options include topical pharmacotherapy (eg, fluorouracil, imiquimod) or procedural interventions (eg, cryotherapy, electrosurgery, surgical vermillionectomy, laser resurfacing), each with their known advantages and disadvantages.2 There is little consensus as to which treatment options offer the most clinical utility given the paucity of comparative clinical data. In my practice, laser resurfacing has become an important tool for the treatment of AC owing to its ease of use and overall safety, tolerability, and cosmetic acceptability. Herein the use of erbium laser resurfacing is described for three AC presentations for which I find it particularly useful: clinically prominent AC, biopsy-proven AC, and treatment of the entire lip following complete tumor excision of SCC. All patients were treated with a 2940-nm erbium laser (Sciton Profile Contour Tunable Resurfacing Laser [TRL], Sciton, Inc., Palo Alto, CA).

Case presentations

Case 1

This 44-year-old female with no history of skin cancer was seen for a routine skin check visit when AC was clinically observed.
The patient underwent one session of erbium laser resurfacing of the entire lower lip, which consisted of 6 passes of 30 μm each (with no coagulation) until pinpoint bleeding occurred. Before and after treatment photos are shown in Figure 1.

Case 2

This 56-year-old female with no prior history of skin cancer was referred for treatment of biopsy-confirmed AC of the right lower lip. A week later, the patient underwent one session of erbium laser resurfacing of the entire lower lip, which consisted of 3 passes of 50 μm each and then one pass to 40 μm (with no coagulation) until pinpoint bleeding occurred. Pre-treatment, immediate posttreatment, and follow-up photos are shown in Figure 2.

Case 3

This 66-year-old male was referred for treatment of a biopsyproven SCC in situ on the mucosa of the right medial lower lip. Due to the presence of significant hyperkeratotic changes at the vermilion border throughout the lower lip, the entire lower lip was treated with fluorouracil cream for 4 weeks before the tumor was excised using the Mohs micrographic technique in order to clean-up the significant sun-damage surrounding the tumor. Mohs surgery was then performed, and once tumor-free margins were reached the patient elected to let the surgical defect heal by second intention. Two months later, erbium laser resurfacing of the entire lip was performed, which consisted of 2 passes of 50 μm each and then one pass to 30 μm (with no coagulation) until pinpoint bleeding occurred. Treatment history is depicted photographically with photos from day of Mohs surgery, immediately after laser resurfacing of lip, and then follow-up at two months (Figure 3).