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).
