Plasma cell cheilitis: the diagnosis of a disorder mimicking lip cancer

Abstract

Plasma cell cheilitis (PCC) is an inflammatory disorder of unknown etiology that affects the lip. It is characterized histologically by a dense infiltrate of plasma cells with a variety of clinical features. The response to different therapeutic modalities is controversial, especially regarding the effectiveness of corticosteroids. We present a case of a 56-year-old Caucasian man with a painful ulcerated and crusted area in the lower lip, resembling a squamous cell carcinoma or actinic cheilitis. Topical corticosteroid was used for one week, which resulted in partial regression and motivated a biopsy. The histological examination provided the diagnosis of PCC. The patient has been disease-free for six months. We also provide a discussion on the criteria of differential diagnosis and management of this rare condition.

Clinico-Pathological Profile and Outcomes of 45 Cases of Plasma Cell Gingivitis

“…Only in a few patients was it possible to identify a specific local irritant, and a proven clinical remission that follows its removal, usually aided with non-surgical periodontal treatment [ 12 , 33 ]. Sporadic speculations were formulated about the possible roles that Candida albicans [ 6 , 10 , 34 ], herpes virus [ 35 ], and chronic mechanical damage [ 25 , 36 , 37 ] may or may not have played in the pathogenetic mechanism. Several cases of plasma cell lesions have been documented in “plaque-related” anatomical areas, associated with generalized periodontitis [ 12 , 33 ], but the role of dental plaque in PCG is still confusing and worthy of further studies [ 38 , 39 ].…”

“…The histological appearance consists of a dense and massive plasma cell infiltration into subepithelial connective tissue. PCG could mimic a wide range of life-threatening entities such as squamous cell carcinoma, autoimmune mucocutaneous bullous diseases (AMBDs), and lymphoproliferative disorders [ 2 , 25 , 26 ]. Plasma cell proliferation is also associated with some infectious diseases, such as syphilis [ 27 ], Castleman’s disease [ 28 ], a primary infectious disease of the lymph node, and, recently, COVID-19 [ 29 ].…”

A Severe Presentation of Plasma Cell Cheilitis

“…5 Differential Diagnosis-The clinical differential diagnosis of PCC is broad and includes inflammatory, infectious, and neoplastic causes, such as actinic cheilitis, allergic contact cheilitis, exfoliative cheilitis, granulomatous cheilitis, lichen planus, candidiasis, syphilis, and squamous cell carcinoma of the lip. 7,9 The histologic differential diagnosis includes allergic contact cheilitis, secondary syphilis, actinic cheilitis, squamous cell carcinoma, cheilitis granulomatosa, and plasmacytoma. [17][18][19] Histopathology-On biopsy, PCC usually is characterized by plasma cells in a bandlike pattern in the upper submucosa or even more diffusely throughout the submucosa.…”

“…6,7,[10][11][12][13][14][15][16] The success of topical corticosteroids, as demonstrated in our case, has been unpredictable; the reported response has ranged from complete resolution to failure. 9 This variability is thought to be related to epithelial width and the degree of acanthosis, with ulcerative lesions demonstrating a superior response to topical corticosteroids. 9…”

“…5 The diagnosis of PCC is challenging because it can mimic neoplastic, infectious, and inflammatory conditions. 8,9 Treatment strategies for PCC described in the literature vary, as does therapeutic response. Resolution of PCC has been documented after systemic steroids, intralesional steroids, systemic griseofulvin, and topical calcineurin inhibitors, among other agents.…”