RESUMEN
INTRODUCTION: Granulomatous cheilitis is a rare disorder characterized by recurrent, idiopathic, and painless lip swelling. The diagnosis is proven by histopathological examination. The unknown aetiology and poorly understood underlying mechanism contribute to the difficulty in establishing an effective treatment. This case study proposes the effectiveness of radiofrequency therapy in the management of refractory granulomatous cheilitis. CASE SUMMARY: A 68-year-old patient presented with hypertrophy and swelling of the lower lip, and a biopsy revealed actinic cheilitis. The patient underwent lip shaving and an advancement mucosal flap, and definitive histologic examination confirmed the diagnosis of granulomatous cheilitis. No other signs of orofacial granulomatosis were observed, and the complementary aetiological study was negative for systemic disease. The lip swelling reappeared and persisted, which interfered with the quality of life. Hence, radiofrequency therapy was performed in the submucosal and subdermal layers of the lip, resulting in significant aesthetic and functional improvement and no further relapses after five years. DISCUSSION: The management of granulomatous cheilitis is challenging. The current mainstay treatment is corticotherapy or reduction cheiloplasty in severe cases. Radiofrequency has potential as a treatment option in debilitating macrocheilia, presenting worthy long-lasting functional and aesthetical results, with minimal morbidity.
Asunto(s)
Queilitis , Síndrome de Melkersson-Rosenthal , Terapia por Radiofrecuencia , Humanos , Anciano , Síndrome de Melkersson-Rosenthal/diagnóstico , Síndrome de Melkersson-Rosenthal/patología , Síndrome de Melkersson-Rosenthal/cirugía , Calidad de Vida , Recurrencia Local de Neoplasia , Queilitis/etiología , Queilitis/cirugíaAsunto(s)
Carcinoma Basocelular/cirugía , Carcinoma de Células Escamosas/cirugía , Neoplasias de los Labios/cirugía , Neoplasias Cutáneas/cirugía , Herida Quirúrgica/cirugía , Técnicas de Cierre de Heridas , Adulto , Anciano , Queilitis/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cirugía de Mohs/efectos adversos , Mucosa Bucal , Herida Quirúrgica/etiología , Cicatrización de HeridasAsunto(s)
Algoritmos , Enfermedades de los Labios/diagnóstico , Enfermedades de los Labios/cirugía , Adulto , Anciano , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/cirugía , Queilitis/diagnóstico , Queilitis/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Neoplasias de los Labios/diagnóstico , Neoplasias de los Labios/cirugía , Lupus Eritematoso Discoide/diagnóstico , Lupus Eritematoso Discoide/cirugía , Masculino , Persona de Mediana EdadRESUMEN
RESUMEN Fundamento: La técnica del tonel de Schuchardt, está indicada cuando el defecto en el labio compromete del 30-75 % del labio, de localización central y paramedial que afecta bermellón y piel; en este caso se usó el colgajo para reconstruir una lesión tumoral más lateral. La técnica aparece descrita para extraer el tonel de espesor parcial, sin embargo, teniendo en cuenta el margen oncológico recomendado en este caso la excéresis abarcó todo el espesor del labio. Objetivo: Presentar un caso de un paciente con un carcinoma epidermoide del 40 % en el labio inferior intervenido en el Hospital General Camilo Cienfuegos. Presentación del caso: Paciente masculino de 43 años de edad tratado durante un año por queilitis actínica, portador de una lesión exofítica, infiltrante que ocupaba el 40 % del labio inferior. Se estableció como impresión diagnóstica un carcinoma epidermoide y se decidió el tratamiento quirúrgico. Atendiendo a las características individuales del paciente y a las de la lesión, se eligió la técnica del tonel descrita por Schuchardt. Conclusiones: Las lesiones malignas de los labios pueden incidir enmascaradas por el cuadro clínico de lesiones premalignas como la queilitis actínica por lo que es importante mantener un seguimiento estrecho de estos casos. Al aplicar el método clínico puede decidirse la intervención quirúrgica con diagnóstico presuntivo de carcinoma epidermoide, deben respetarse entonces los márgenes oncológicos recomendados. La técnica del tonel inicialmente descrita para pérdidas de tejidos mediales y paramediales del labio, de espesor parcial puede emplearse en defectos de localización más lateral y de espesor total con resultados satisfactorios.
ABSTRACT Background: The barrel of Schuchardt technique, is indicated when the defect in the lip compromises 30-75 % of it, from central to paramedial location which affects both, vermilion and skin; in this case, the flap was used for rebuilding a more lateral tumor lesion. The technique is described to extract the partial thickness barrel; however, taking into account the oncological margin recommended in this case, the hysteresis covered the entire thickness of the lip. Objective: To present a case of a patient with 40 % squamous cell carcinoma in the lower lip intervened at Camilo Cienfuegos General Hospital. Case report: A 43-year-old male patient treated for a year having actinic cheilitis, with an infiltrated exophytic lesion, occupying 40 % of the lower lip. A squamous cell carcinoma was diagnosed, so surgical treatment. Based on the individual characteristics of the patient and those of the lesion, the barrel technique described by Schuchardt was chosen. Conclusions: Malignant lesions of the lips can affect masked by the clinical picture of premalignant lesions such as actinic cheilitis, so it is important to keep a close follow-up of these cases. When applying the clinical method, the surgical intervention with presumptive diagnosis of squamous cell carcinoma can be decided, then the recommended oncological margins must be respected. The barrel technique initially described for losses of medial and paramedial tissues of the lip, of partial thickness can be used in defects of more lateral location and of total thickness with satisfactory results.
Asunto(s)
Neoplasias de los Labios/cirugía , Carcinoma de Células Escamosas/cirugía , Queilitis/cirugíaRESUMEN
Potentially malignant disorders (PMD) have a high risk of malignant transformation. Habits such as tobacco and alcohol use predispose to PMD and subsequently to an oral carcinoma. Oral squamous cell carcinoma (OSCC) can occur even without the usage of tobacco. Occupational exposure to actinic rays may predispose to the development of OSCC in the lip. People who are involved in farming or those exposed to an environmental background radiation, such as ultraviolet rays, develop a PMD called actinic cheilosis. A high proportion of patients with actinic cheilosis develop an oral carcinoma when not diagnosed and treated in early stages. This case depicts the clinical and histological changes in a 61-year-old Indian man with actinic cheilosis.
Asunto(s)
Queilitis/cirugía , Neoplasias de la Boca/prevención & control , Enfermedades Profesionales/cirugía , Intervención Médica Temprana/métodos , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
BACKGROUND: Early identification and treatment of actinic cheilitis (AC) is recommended. Although photodynamic therapy (PDT) is an attractive therapeutic option for AC, PDT for AC does not result in the same satisfactory outcomes as in actinic keratosis (AK). OBJECTIVES: The aim of our study was to compare efficacy, recurrence rate, cosmetic outcome and safety between erbium:yttrium-aluminium-garnet ablative fractional laser-assisted methyl aminolaevulinate-PDT (Er:YAG AFL MAL-PDT) and standard MAL-PDT. METHODS: Thirty-three patients with histologically confirmed AC randomly received either one session of Er:YAG AFL MAL-PDT or two sessions of MAL-PDT. In the MAL-PDT group, the second session of MAL-PDT was administered 7 days later. Patients were followed up at 1 week and 3 and 12 months, and biopsies were taken from all patients at 3 and 12 months after the last treatment session. At the final 12-month follow-up, cosmetic outcomes were assessed. Adverse events were assessed at week 1 of the treatment phase and every subsequent follow-up visit. RESULTS: In the per-protocol (PP) population, Er:YAG AFL MAL-PDT was significantly more effective (92% complete response rate) than MAL-PDT (59%; P = 0.040) at the 3-month follow-up, and differences in efficacy remained significant at the 12-month follow-up (85% in Er:YAG AFL MAL-PDT and 29% in MAL-PDT). The recurrence rate was significantly lower for Er:YAG AFL MAL-PDT (8%) than for MAL-PDT (50%) group at 12 months (P = 0.029). No significant difference in cosmetic outcome or safety was observed between Er:YAG AFL MAL-PDT and MAL-PDT. CONCLUSIONS: Ablative fractional laser pretreatment has significant benefit for the treatment of AC with PDT.
Asunto(s)
Queilitis/tratamiento farmacológico , Terapia por Láser/métodos , Fotoquimioterapia/métodos , Anciano , Ácido Aminolevulínico/análogos & derivados , Ácido Aminolevulínico/uso terapéutico , Queilitis/cirugía , Terapia Combinada , Femenino , Humanos , Láseres de Estado Sólido/uso terapéutico , Masculino , Fármacos Fotosensibilizantes/uso terapéutico , Estudios Prospectivos , Recurrencia , Resultado del TratamientoRESUMEN
Actinic cheilitis is a precancerous condition characterized by grayish-whitish area(s) of discoloration on the mucosal lip, often blunting the demarcation between mucosa and cutaneous lip. Actinic cheilitis is considered to be an early part of the spectrum of squamous cell carcinoma. Squamous cell carcinoma specifically of the lip has a high rate of recurrence and metastasis through the oral cavity leading to a poor overall survival. Risk factors for the development of actinic cheilitis include chronic solar irradiation, increasing age, male gender, light skin complexion, immunosuppression, and possibly tobacco and alcohol consumption. 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. 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 actinic cheilitis owing to its ease of use and overall safety, tolerability, and cosmetic acceptability. Herein the use of erbium laser resurfacing is described for three actinic cheilitis presentations for which I find it particularly useful: clinically prominent actinic cheilitis, biopsy-proven actinic cheilitis, and treatment of the entire lip following complete tumor excision of squamous cell carcinoma. All patients were treated with a 2940-nm erbium laser (Sciton Profile Contour Tunable Resurfacing Laser [TRL], Sciton, Inc., Palo Alto, CA).
Asunto(s)
Queilitis/cirugía , Láseres de Estado Sólido/uso terapéutico , Lesiones Precancerosas/cirugía , Adulto , Anciano , Biopsia , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Queilitis/patología , Femenino , Humanos , Neoplasias de los Labios/patología , Neoplasias de los Labios/cirugía , Masculino , Persona de Mediana Edad , Lesiones Precancerosas/patología , Factores de RiesgoRESUMEN
Lip abscesses are a potentially serious condition rarely reported in the medical literature. This disease requires prompt diagnosis and treatment with hospitalization, intravenous antibiotics, and urgent surgical drainage. Clinical knowledge of this condition is essential to guide the differential diagnosis and correctly adapt the etiological treatment. The presence of necrotic and cavitated lesions requires ruling out immunosupression or methicillin-resistant agent. We report a necrotic and cavitated bacterial lip abscess caused by methicillin-sensitive Staphylococcus aureus in an immunocompetent male.
Asunto(s)
Absceso/etiología , Queilitis/etiología , Infecciones Cutáneas Estafilocócicas/diagnóstico , Absceso/tratamiento farmacológico , Absceso/inmunología , Absceso/microbiología , Absceso/cirugía , Adulto , Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Antibacterianos/uso terapéutico , Queilitis/tratamiento farmacológico , Queilitis/inmunología , Queilitis/microbiología , Queilitis/cirugía , Cloxacilina/uso terapéutico , Terapia Combinada , Drenaje , Humanos , Inmunocompetencia , Masculino , Mupirocina/uso terapéutico , Infecciones Cutáneas Estafilocócicas/tratamiento farmacológico , Infecciones Cutáneas Estafilocócicas/inmunología , Infecciones Cutáneas Estafilocócicas/cirugía , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/aislamiento & purificaciónRESUMEN
BACKGROUND: Vermilionectomy is an excisional technique for the treatment of lower lip squamous cell carcinoma and actinic cheilitis. The vermilionectomy defect is usually repaired by a labial mucosal advancement flap. Traditionally, the mucosal wound margins are widely undermined but this can be associated with significant postoperative morbidity. OBJECTIVES: We describe our experience with a modified technique whereby lower lip vermilionectomy defects were repaired by direct primary closure without undermining and present the subsequent cosmetic, functional and sensory results. METHODS AND MATERIALS: This is a retrospective case series of 21 patients who underwent vermilionectomy repair by direct closure without undermining. Combined data regarding the presence of any postoperative sensory, functional or cosmetic disturbance are presented. RESULTS: Complete data were available for 17 patients. Minimal sensory disturbance was noted in 10·5% of our patients 6 months postoperatively, which is less than previous studies. Similarly, labial scar tension was less frequent in our series; 94% of the patients were satisfied with cosmesis. CONCLUSIONS: Direct closure without undermining is a simple, reproducible technique for repair of lower lip vermilionectomy defects and leads to excellent cosmetic, functional and sensory results in the majority of patients.
Asunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias de los Labios/cirugía , Procedimientos de Cirugía Plástica/métodos , Complicaciones Posoperatorias/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Queilitis/cirugía , Femenino , Humanos , Labio/cirugía , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Complicaciones Posoperatorias/psicología , Estudios Retrospectivos , Colgajos Quirúrgicos , Encuestas y Cuestionarios , Resultado del Tratamiento , Cicatrización de HeridasRESUMEN
The differential diagnosis of SC includes malignant, premalignant, metastatic, inflammatory, and eczematoid disorders, along with photodermatoses and a few rare but important disorders of the lower lip. Current treatment options include topical, ablative, and surgical therapies. Several clinical challenges are also addressed, including the issue of obtaining a high-yield diagnostic biopsy specimen while minimizing patient morbidity, field-directed treatment for SC, and strategies for combination therapy.
Asunto(s)
Carcinoma de Células Escamosas/terapia , Queilitis/terapia , Neoplasias de los Labios/terapia , Neoplasias Cutáneas/terapia , Administración Tópica , Aminoquinolinas/administración & dosificación , Aminoquinolinas/uso terapéutico , Biopsia , Queilitis/patología , Queilitis/cirugía , Terapia Combinada , Diagnóstico Diferencial , Diclofenaco/administración & dosificación , Diclofenaco/uso terapéutico , Femenino , Fluorouracilo/administración & dosificación , Fluorouracilo/uso terapéutico , Humanos , Imiquimod , Masculino , Persona de Mediana Edad , Lesiones Precancerosas/terapia , Luz Solar/efectos adversosRESUMEN
BACKGROUND: Chronic actinic cheilitis is actinic keratosis located on the vermilion border. Treatment is essential because of the potential for malignant transformation. OBJECTIVE: To evaluate the aesthetic and functional results of vermilionectomy using the classic and W-plasty techniques in actinic cheilitis. In the classic technique, the scar is linear and in the W-plasty one, it is a broken line. METHODS: 32 patients with clinical and histopathological diagnosis of actinic cheilitis were treated. Out of the 32 patients, 15 underwent the W-plasty technique and 17 underwent the classic one. We evaluated parameters such as scar retraction and functional changes. RESULTS: A statistically significant association between the technique used and scar retraction was found, which was positive when using the classic technique (p = 0.01 with Yates' correction). The odds ratio was calculated at 11.25, i.e., there was a greater chance of retraction in patients undergoing the classic technique. Both techniques revealed no functional changes. We evaluated postoperative complications such as the presence of crusts, dry lips, paresthesia, and suture dehiscence. There was no statistically significant association between complications and the technique used (p = 0.69). CONCLUSION: We concluded that vermilionectomy using the W-plasty technique shows better cosmetic results and similar complication rates.
Asunto(s)
Queilitis/cirugía , Cicatriz/cirugía , Labio/cirugía , Procedimientos de Cirugía Plástica/métodos , Adulto , Factores de Edad , Anciano , Carcinoma de Células Escamosas/prevención & control , Distribución de Chi-Cuadrado , Femenino , Humanos , Neoplasias de los Labios/prevención & control , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Lesiones Precancerosas/prevención & control , Factores de Riesgo , Factores Sexuales , Resultado del TratamientoRESUMEN
FUNDAMENTO: A queilite actínica crônica é a ceratose actínica localizada no vermelhão labial. O tratamento é de crucial importância, devido ao potencial de transformação maligna. OBJETIVO: Avaliar os resultados estéticos e funcionais das vermelhectomias clássica e em W-plastia na queilite actínica. Na técnica clássica, a cicatriz é linear; na W-plastia, em linha quebrada. MÉTODOS: Foram tratados 32 pacientes com diagnóstico clínico e histopatológico de queilite actínica. Quinze deles foram submetidos à técnica em W-plastia e 17, à técnica clássica. Avaliaram-se parâmetros como retração cicatricial e alterações funcionais. RESULTADOS: Houve associação estatisticamente significativa entre a técnica utilizada e a presença de retração cicatricial, sendo a associação positiva com a clássica (p=0,01 com correção de Yates). O risco relativo (odds ratio - OR) calculado foi de 11,25, ou seja, houve maior chance de retração nos pacientes submetidos à técnica clássica. Nenhuma das técnicas apresentou alterações funcionais. Avaliaram-se complicações pós-operatórias como presença de crostas, lábios secos, parestesia e deiscência de sutura. Não houve associação estatisticamente significante entre as complicações e a técnica utilizada (p=0,69). CONCLUSÃO: Concluiu-se que a vermelhectomia em W-plastia oferece melhores resultados estéticos e índices de complicações semelhantes.
BACKGROUND: Chronic actinic cheilitis is actinic keratosis located on the vermilion border. Treatment is essential because of the potential for malignant transformation. OBJECTIVE: To evaluate the aesthetic and functional results of vermilionectomy using the classic and Wplasty techniques in actinic cheilitis. In the classic technique, the scar is linear and in the W-plasty one, it is a broken line. METHODS: 32 patients with clinical and histopathological diagnosis of actinic cheilitis were treated. Out of the 32 patients, 15 underwent the W-plasty technique and 17 underwent the classic one. We evaluated parameters such as scar retraction and functional changes. RESULTS: A statistically significant association between the technique used and scar retraction was found, which was positive when using the classic technique (p = 0.01 with Yates' correction). The odds ratio was calculated at 11.25, i.e., there was a greater chance of retraction in patients undergoing the classic technique. Both techniques revealed no functional changes. We evaluated postoperative complications such as the presence of crusts, dry lips, paresthesia, and suture dehiscence. There was no statistically significant association between complications and the technique used (p = 0.69). CONCLUSION: We concluded that vermilionectomy using the W-plasty technique shows better cosmetic results and similar complication rates.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Queilitis/cirugía , Cicatriz/cirugía , Labio/cirugía , Procedimientos de Cirugía Plástica/métodos , Factores de Edad , Distribución de Chi-Cuadrado , Carcinoma de Células Escamosas/prevención & control , Neoplasias de los Labios/prevención & control , Complicaciones Posoperatorias , Lesiones Precancerosas/prevención & control , Factores de Riesgo , Factores Sexuales , Resultado del TratamientoRESUMEN
BACKGROUND: Post-vermilionectomy defect closure by a mucosal advancement flap is a well-established method, although moderate morbidity may accompany the procedure, especially in elderly patients. The objective of the present study was to compare a simple primary closure (PC) for reconstruction after complete resection of the vermilion (vermilionectomy) with closure using a mucosal advancement flap (MAF). METHODS: After margin-controlled vermilionectomy, 18 patients with actinic cheilitis (n=5) or squamous cell carcinoma in situ (n=13) of the lower lip were included in the present study. Patients were randomized into one group receiving PC (n=8) and a second group receiving MAF closure (n=10) for reconstruction of the surgical defect on the lower lip. All complications, esthetic outcomes (EOs), and cut-suture times were documented. RESULTS: In the MAF group, patients' mean EO score on a 10-point scale was 8.4, and the surgeons' mean EO rate was 7.8. In the PC group the patients' mean EO score was 7.5 and the surgeons' mean EO rate was 6.4 for the reconstruction achieved. The rate of side effects was significantly higher in the MAF group than in the PC group (p<.05). The cut-suture times were significantly shorter for PC (29 minutes) than MAF (37.8 minutes; p<.05). CONCLUSION: MAF is the method of choice and has good functional and cosmetic outcomes, although elderly patients with different comorbidities that need to be protected from unnecessary strain could potentially benefit from PC.
Asunto(s)
Carcinoma de Células Escamosas/cirugía , Queilitis/cirugía , Enfermedades de los Labios/cirugía , Neoplasias de los Labios/cirugía , Mucosa Bucal/cirugía , Colgajos Quirúrgicos , Anciano , Estética , Humanos , Masculino , Estadísticas no Paramétricas , Resultado del TratamientoRESUMEN
BACKGROUND: Actinic cheilitis is a common condition with the potential to develop into squamous cell carcinoma. Current treatments have varying cure rates and complications. The role of the erbium:yttrium-aluminum-garnet (Er:YAG) laser in the treatment of actinic cheilitis has not been widely published, despite offering theoretical advantages over current treatment modalities. OBJECTIVE: To evaluate the outcome of a series of patients treated with the Er:YAG laser for actinic cheilitis. METHODS: This was a retrospective, interventional, nonrandomized, sequential case series set in a tertiary referral, dermatologic surgery unit. Ninety-nine consecutive patients with actinic cheilitis treated with the Er:YAG laser between January 2001 and June 2008 underwent a case note review, of which 77 went on to a structured telephone interview. The main outcome measures were a subjective improvement in lip symptoms related to actinic cheilitis and objective improvement in the lips at routine follow-up. RESULTS: Mean time to interview follow-up was 65.7 months. Of those interviewed, 92.2% believed there had been an improvement in the cosmetic appearance of their lips; one hundred percent believed the function of their lips had improved or remained unchanged; and 84.8% remained completely disease free at the time of follow-up. The majority of patients (93.5%) were satisfied with the laser treatment. Scarring as a direct result of the laser occurred in 5.1% of patients. LIMITATIONS: Retrospective nature of data collection; inability to interview all patients who underwent treatment. CONCLUSION: The Er:YAG laser is a successful modality for the treatment of actinic cheilitis with good functional and cosmetic results and only a small risk of long-term scarring. It should be considered as a first-line treatment for the disease.
Asunto(s)
Queilitis/patología , Queilitis/cirugía , Terapia por Láser/métodos , Láseres de Estado Sólido , Lesiones Precancerosas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/prevención & control , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Lesiones Precancerosas/patología , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/prevención & control , Resultado del TratamientoRESUMEN
A queilite actínica é uma alteração dos lábios causada pela exposição crônica aos raios solares ultravioleta. É comum em indivíduos idosos de pele clara e que mantêm hábitos ocupacionais ou de lazer ao ar livre, expondo-se à radiação actínica. Este trabalho comenta as características clínicas e a relação com os achados microscópicos, assim como o diagnóstico e formas de tratamento da queilose actínica. É ressaltada a importância de sua detecção precoce, da instituição de medidas preventivas e do controle clínico dos pacientes visando evitar o desenvolvimento do câncer de lábio inferior. O presente estudo buscou demonstrar um caso clínico de queilose actínica no qual serão observadas fotos de todo o tratamento, desde sua detecção clínica (observação da lesão difusa, em placa, com bordos levemente eritematosos e pequenos pontos de solução de continuidade), comprovação histopatológica através de biópsia incisional, etapas cirúrgicas até o pós-operatório de 3 meses, observando-se cicatrização total e ausência da lesão pré-existente. Logo, torna-se de grande importância o conhecimento deste tipo de lesão já que seu alto potencial de malignização para carcinoma de células escamosas apresenta grande risco à saúde geral do paciente, levando-o a posteriores mutilações ou até mesmo ao óbito por metástase, caso haja a instalação e progressão do carcinoma epidermóide.
Actinic cheilitis is a change in the lips caused by chronic exposure to ultraviolet sun rays. It is common in older, fair skin individuals who work outdoors or have outdoor leisure activities and are constantly exposed to actinic radiation. This work discusses the clinical characteristics and their relationship with the microscopic findings, as well as diagnosis and treatment options for actinic cheilitis. The importance of early detection, implementation of preventive measures and clinical control of the patients to avoid lower lip cancer is emphasized. The present study presents a clinical case of actinic cheilitis with pictures taken during the entire treatment, including clinical detection (diffuse lesion, in plaque, with slightly erythematous borders and some loss of the sharp border between lip and skin), histopathological confirmation by incisional biopsy, surgical stages and 3 months after surgery, showing complete healing and absence of the preexisting lesion. This, knowledge of this type of lesion is critical because of its potential to develop into squamous cell carcinoma, which would represent a great risk for the general health of the patient who would later need to be mutilated or even die due to metastases if carcinoma develops and progresses.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Queilitis/cirugía , Queilitis/diagnósticoAsunto(s)
Adenolinfoma/patología , Queilitis/etiología , Neoplasias de los Labios/patología , Neoplasias de las Glándulas Salivales/patología , Glándulas Salivales Menores/patología , Adenolinfoma/complicaciones , Adenolinfoma/cirugía , Negro o Afroamericano , Queilitis/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Neoplasias de los Labios/complicaciones , Neoplasias de los Labios/cirugía , Persona de Mediana Edad , Neoplasias de las Glándulas Salivales/complicaciones , Neoplasias de las Glándulas Salivales/cirugía , Glándulas Salivales Menores/cirugía , Trasplante de PielRESUMEN
BACKGROUND: During the past 15 years, polymethylmethacrylate has been used as a synthetic permanent filler for soft-tissue augmentation. METHODS: This article reports 32 cases of complications seen at Hospital das Clínicas, Faculty of Medicine, University of São Paulo, for procedures performed elsewhere. RESULTS: The average age of the patients was 43.6 years (range, 22 to 70 years). Twenty-five patients were women. Sixteen injection procedures were performed by certified plastic surgeons, nine by dermatologists, two by urologists, and one by a nonphysician. Complications were classified into five groups according to main presentation as follows: tissue necrosis (five cases), an acute complication that can be related to technical mistakes but that can also be dependent on patient factors or caused by local infection; granuloma (10 cases), which usually presents as a subacute complication 6 to 12 months after the procedure; chronic inflammatory reactions (10 cases), which usually occur years later and can be related to a triggering event, such as another operation or infection in the area that was injected (these reactions are immunogenic in origin and may have cyclic periods of activation and remission); chronic inflammatory reaction in the lips (six cases), which may be present with severe symptoms, especially with lymphedema, because of mobility of the lip; and infections (one case), which are rare but possible complications after filling procedures. CONCLUSIONS: Polymethylmethacrylate filler complications, despite being rare, are often permanent and difficult or even impossible to treat. Safety guidelines should be observed when considering use of polymethylmethacrylate for augmentation.