Lip lesions are common. They may be extremely painful and interfere with speech and feeding. They may be socially embarrassing for the patient. They may also prevent appropriate contact with a partner, leading to emotional problems. In the elderly, carcinoma is a common cause of a lump on the lip, especially in those with outdoor occupations. Acquired Raised Lesions Figure 44 A squamous cell carcinoma on the lower lip. Cleft lip occurs due to failure of fusion of the nasal and maxillary processes which form the upper lip and the maxilla. The only abnormality may be a slight indentation in the outer part of the middle third of the upper lip. However, it may extend to the anterior nares. It may be associated with a cleft palate. The condition may be unilateral or bilateral. Abnormal phonation occurs. Junctional naevi develop at or before puberty. Ensure that there has been no change in a junctional naevus to suggest development of malignant melanoma. In Peutz–Jeghers syndrome, pigmentation will be on the gums as well as the lips. There will usually be a family history (autosomal dominant). These pigmented lip lesions do not become malignant. There may be associated history of bowel problems, e.g. bleeding or intussusception. In hereditary telangiectasia, the patient may also have noticed lesions in the mouth and on the skin, especially the fingertips.
Lip Lesions
Causes
The patient, a man of 60, had smoked a pipe for most of his life. He presented with a non-healing ulcer of the lip, which proved to be a well-differentiated squamous cell carcinoma on biopsy.
History
Congenital
Acquired
Flat lesions
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Lesions
