Vermilionectomy followed by reconstruction of the vermilion mucosa using allograft dermal matrix in patients with actinic cheilitis of the lower lip

Efficacy and tolerability of 1.6% phenol-croton peeling vs. topical 5% imiquimod in the treatment of actinic cheilitis: a randomized controlled trial

BACKGROUND

Trials evaluating the effectiveness of topical treatments for actinic cheilitis (AC) are scarce. Despite no comparative data, phenol-croton peeling has been reported as effective in treating this condition.

OBJECTIVE

To assess for the treatment of AC the efficacy and tolerability of a single session of 1.6% phenol-croton peeling vs. topical 5% imiquimod cream applied for 30 days for the treatment of AC.

METHODS

An open, randomized controlled trial was conducted to compare the effectiveness and tolerability of 1.6% phenol-croton peeling vs. topical 5% imiquimod for the treatment of AC [protocol registered at ReBEC (Brazilian Registry of Clinical Trials) - RBR-1044sz68]. Thirty-six patients with biopsy-proven AC were allocated into two groups (1 : 1): the imiquimod group received 5% topical imiquimod three times a week for 30 days, and the croton group underwent one session of 1.6% phenol-croton peeling. The primary outcome was the clearance of AC after 56 days. Secondary outcomes included clinical and histological parameters, adverse effects and clinical results after 180 days.

RESULTS

Complete clinical clearance of AC (defined as clearance of both leukoplakia and hyperkeratosis) at day 56 and day 180 occurred in 17 of 18 (94%) participants from the croton group but in none of the 18 participants in the imiquimod group (P < 0.01). Improvement in all clinical parameters was more prominent in the croton group (P ≤ 0.01). Complete histological normalization at day 56 occurred in 72% of the croton group and only 17% in the imiquimod group (P < 0.01). Histological parameters such as atypia (keratinocyte intraepithelial neoplasia score), solar elastosis and hyperkeratosis reduced in intensity only in the croton group (P < 0.05). Adverse effects were most intense on day 7 in the croton group and persisted until day 21 in the imiquimod group. The study was prematurely terminated at the interim analysis.

CONCLUSIONS

A single session of 1.6% phenol-croton peeling produced clinically and histologically superior results with a shorter recovery period compared with imiquimod for treating AC.

Solar cheilosis: a comprehensive narrative review

Solar cheilosis is a premalignant disease of the lip, typically presenting on the lower lip as a precursor to in situ squamous cell carcinoma. It is primarily caused by chronic exposure to sunlight and predominantly affects individuals with lighter skin pigmentation. This review explores solar cheilosis while providing an update on its epidemiology, etiology, pathogenesis, disease course, and other recent advancements. Specifically, we discuss the various molecular markers involved in the pathogenesis of solar cheilosis and their respective functions. Through our analysis, we aim to highlight the various clinical manifestations of solar cheilosis, emphasizing the importance of early detection, assessing risk factors, and analysis of histopathology to help confirm a diagnosis of solar cheilosis. Finally, we outline the latest available treatment modalities, ranging from conservative (non-surgical) approaches to surgical approaches. These conservative approaches include the use of laser therapy, topical agents, photodynamic therapy, and cryotherapy, while the most frequently employed surgical approach for treating solar cheilosis involves vermilionectomy.

Use of Biologic Agents for Lip and Cheek Reconstruction

The unique requirements of reconstructing cheek defects, often with its proximity to the mobile elements of the face including the lip and the eyelid, have been met very handily with the directed and thoughtful use of biologic wound healing agents. One of the key advantages of these agents is their ability to provide coverage for the mobile elements of the cheek and the lip in patients with multiple co-morbidities. These agents are successfully used where the standard cheek closure techniques including cervicofacial advancement flap are contraindicated due to its anesthetic requirement. Additionally, lip reconstruction involves examining the lip's three anatomic layers: mucosa, muscle, and skin. The defects must be planned for reconstruction based on the involvement of these layers. This paper serves to introduce the use of biologic wound healing agents depending on the involvement of these layers. The authors provide specific illustrations of these agents based on defect location, tissue involvement, and severity of the defect to help with procedural planning to reconstruct a very aesthetically involved part of the face.

Use of Biologic Agents for Lip and Cheek Reconstruction

The unique requirements of reconstructing cheek defects, often with its proximity to the mobile elements of the face including the lip and the eyelid, have been met very handily with the directed and thoughtful use of biologic wound healing agents. One of the key advantages of these agents is their ability to provide coverage for the mobile elements of the cheek and the lip in patients with multiple co-morbidities. These agents are successfully used where the standard cheek closure techniques including cervicofacial advancement flap are contraindicated due to its anesthetic requirement. Additionally, lip reconstruction involves examining the lip's three anatomic layers: mucosa, muscle, and skin. The defects must be planned for reconstruction based on the involvement of these layers. This paper serves to introduce the use of biologic wound healing agents depending on the involvement of these layers. The authors provide specific illustrations of these agents based on defect location, tissue involvement, and severity of the defect to help with procedural planning to reconstruct a very aesthetically involved part of the face.