Actinic cheilitis, also called farmer's lip

The condition usually involves the exposed lower lip after repeated ultraviolet exposure. It is regarded as a precancerous change because abnormal lip cells can progress to squamous cell carcinoma, although a clinician cannot determine that from dryness alone.

Actinic cheilitis may make the lip persistently rough, scaly, dry or cracked. Pale, white, red or yellowish areas can appear, and the sharp border between the pink lip and nearby skin may become blurred. Tenderness, crusting or a localised thick patch may develop. These findings can overlap with irritant, allergic and inflammatory lip conditions.

Long periods working outdoors gave rise to the traditional name, but the condition can affect anyone with cumulative sun exposure. Fair skin, a history of sunburned lips, outdoor work or recreation, and smoking can increase concern during an assessment.

Arrange a dermatologist or oral-health assessment for a lip patch that does not settle. Until then, limit direct sun, use a broad-brimmed hat, apply a broad-spectrum lip sunscreen regularly, and stop smoking. Do not peel scale or repeatedly treat the area with fragranced balms, acids or scrubs, as irritation can obscure the examination.

A clinician may diagnose the condition by examination and may take a biopsy from a thick, ulcerated or otherwise suspicious area. Depending on the extent and tissue findings, management can include a prescribed field cream, photodynamic therapy, freezing, laser treatment or removal of the affected lip surface.

Seek prompt examination if the lip develops a firm or growing lump, an ulcer that does not heal, repeated bleeding, increasing pain, marked thickening or a persistent focal crust. A new lump in the neck or difficulty swallowing also warrants timely medical review. Urgency follows these changes themselves, not the person's amount of sun exposure.

Ask whether the whole lip is affected or there is one focal area, whether biopsy is advisable, which treatment matches the depth and extent of change, and how the lip may feel and look while healing. Confirm which sunscreen and bland moisturiser can be used during treatment and how often the site should be re-examined.