Actinic lesions in fishermen’s lower lip: clinical, cytopathological and histopathologic analysis

Abstract

INTRODUCTIONActinic cheilitis (AC) is considered to be a pre-malignant lesion or an incipient and superficial form of lip squamous cell carcinoma. It is commonly found in individuals whose occupational activities are related to chronic sun exposure and the definitive diagnosis is performed with biopsy. Althoug Exfoliative cytology has been used as a screening procedure to evaluate cancer of the oral cavity no studies have proposed the use of exfoliative cytologic analysis to evaluate and diagnose AC.OBJECTIVEThe purpose of this study was to evaluate lower lip lesions on fishermen related to chronic solar exposure using clinical, cytologic and histopathologic analyses.PATIENTS AND METHODSSmears taken from the vermilion of the lower lips of 125 fishermen and 30 control individuals were subjected to cytologic analysis.RESULTSThe harvested cells were sufficient for cytologic analysis in 83.2% of the samples. Sixteen fishermen exhibited prominent lower lip lesions that justified biopsy and histological studies. In total, 4 specimens were malignant (3.2%), and 12 displayed epithelial dysplasia, demonstrating that the prevalence of epithelial dysplasia and malignant lesions was high among the fishermen population. These conditions were strongly associated with infiltration and blurring of the vermilion margin of the lower lip.CONCLUSIONThe cytologic analysis was not useful for detecting epithelial dysplasia or malignant alterations.

Prevalence of and risk factors for actinic cheilitis in Brazilian fishermen and women

“…When modifiable factors (daily exposure of >4 hours and non‐use of sunscreens) are removed from the linear function, this probability decreases to 6%, showing that the use of sunscreens and lowering daily exposure to solar radiation are important means of preventing the development of AC. Although the final model used in this study did not reveal a positive association between smoking and AC, some authors state that the disease may be aggravated in smokers because the continuous exposure to heat generated by smoke combustion may accelerate the process of lip carcinogenesis in individuals who are also exposed to solar radiation. Therefore, smoking should also be discouraged, especially among individuals who are exposed to more than one risk factor for the development of oral cancer.…”

“…The findings of other studies conducted to date indicate that AC does not have a uniform distribution, even in Brazil (Table ). These large differences in prevalences of the disease may be explained by several factors, such as the under‐reporting of cases in some regions, geographical location, sample size, type of population studied, and the criteria used for disease classification.…”

“…Histologically, AC may present a number of epithelial changes, ranging from a mild dysplasia to invasive SCC. Basophilic changes in collagen, known as solar elastosis, connective tissue inflammation, and an increased density of tryptase‐positive mast cells are also characteristic . Recently, it was demonstrated that mutations in fibroblast growth factor receptor 3 may contribute to the pathogenesis of AC and lip SCC and that the increase in the density of mast cells associated with the strong expression of matrix metalloproteinase 9 may favor SCC progression …”

Correlation between cell cycle proteins and hMSH2 in actinic cheilitis and lip cancer

“…The rate for malignant transformation of these lesions ranges from 10 to 30 % [28] and solar radiation is the main etiological factor in its development and consequent progression to SCC [9,28].…”

Queilite actínica: avaliação histopatológica de 44 casos

“…A presença de displasia epitelial é um achado comum e foi observada na grande maioria das lesões do presente estudo, corroborando este dado com outros estudos 1,2,6,9,13 . Na presente amostra, nos casos que apresentavam displasia, foi observada uma maior prevalência de displasia leve e displasia moderada, concordando com os resultados de outros autores 1,6,9,15,25,28 . Por outro lado, os resultados de Cavalcante et al 2 (2004), com prevalência de 40,6% e 46,6%, respectivamente.…”