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1</a>C&#41;&#46; Analysis of a skin biopsy specimen revealed acanthotic mucosa with parakeratotic hyperkeratosis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41; and minor salivary gland tissue with ductal dilatation and squamous metaplasia &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46; Abundant plasma cells were observed in the glandular interstitium &#40;CD138<span class="elsevierStyleSup">&#43;</span>&#41;&#44; with absence of light chain restriction&#44; thus ruling out hematologic neoplasia &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>C&#41;&#46; Compact material was visible inside the lumen&#44; extending toward the surface&#46; Periodic acid-Schiff staining was positive &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>D&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Diagnosis&#58; Glandular Cheilitis</span><p id="par0010" class="elsevierStylePara elsevierViewall">Glandular cheilitis &#40;or cheilitis glandularis&#41; has received little attention in the medical literature&#46; First reported by von Volkman in 1879&#44; it is a chronic&#44; persistent disorder characterized by hyperplasia and inflammation of the salivary glands in the lips and may or may not occur with actinic cheilitis&#46; It mainly affects the lower lip&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The excretory ducts appear dilated and inflamed and are seen as red and dotted mucosal macules&#46; The volume of the lip may be increased &#40;macrocheilia and eclabium&#41; in deep and suppurative forms &#40;apostematosa&#41;&#44; although the simple or superficial form &#40;as we describe here&#41; seems to be more common&#46; The simple variant may be characterized by superficial erosions and crusts&#44; whereas the deep variant may involve scarring&#46; This condition is more common in men&#44; and its etiology is unclear&#46; Associated risk factors include chronic actinic damage&#44; smoking&#44; injury&#44; thick saliva production&#44; bacterial infections&#44; and deficient oral hygiene&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#8211;4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Diagnosis is based on clinical findings&#44; although histopathology&#44; while not specific&#44; can prove extremely useful for identifying end-stage inflamed&#44; hyperplastic&#44; atrophic salivary glands&#44; as well as ductal metaplasia and ectasia&#46; The differential diagnosis includes actinic cheilitis&#44; irritant or allergic contact cheilitis&#44; atopic cheilitis&#44; lichen planus&#44; sarcoidosis&#44; granulomatous cheilitis&#44; and actinic pruritus&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Treatment is varied and includes observation and photoprotection&#44; antibiotic therapy&#44; cryotherapy&#44; corticosteroids administered topically or as an infiltration&#44; and vermilionectomy&#44; which is the most effective approach in patients with chronic and suppurative forms&#46; Some authors consider this entity to be premalignant and&#44; therefore&#44; that it requires active treatment&#46; Indeed&#44; glandular cheilitis shares some etiologic and pathogenic factors with actinic cheilitis&#44; although this has never been demonstrated&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In the present case&#44; the clinical manifestations and histopathology findings were consistent with glandular cheilitis&#46; The patient was asymptomatic and preferred to avoid invasive treatments&#46; Therefore&#44; we opted for a conservative approach involving the suppression of predisposing factors&#44; rigorous photoprotection&#44; and close monitoring&#44; which&#44; moreover&#44; was necessary owing to the patient&#39;s history of skin cancer&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> Glandular cheilitis is infrequently reported and probably underdiagnosed&#44; and its dermoscopic characteristics have not been discussed to date&#46; We report a case in which the lesions were very striking&#46; Health professionals should become aware of this condition given its role as an indirect marker of chronic actinic damage of the lip and&#44; therefore&#44; the associated increased risk of neoplasm&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of Interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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Case and Research Letter
Glandular Cheilitis: Rare or Underdiagnosed?
Queilitis glandular. ¿Una entidad rara o infradiagnosticada?
R. García Castro
Autor para correspondencia
, L. Revelles Peñas, M. Roncero Riesco, E. Godoy Gijón
Servicio de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario de Salamanca, Salamanca, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">An 80-year-old farmer attended the dermatology-oncology clinic for a regular examination of several cutaneous squamous cell carcinomas &#40;pT1&#41; on the face that had been removed some years earlier&#46; He had stopped smoking 25 years before the visit &#40;60 pack-years for 40 years&#41;&#46; The physical examination was remarkable not only for leukoplakia and thick scaling of the vermillion border of both lips&#44; but also for the presence of tiny erythematous monomorphic lesions arranged regularly on the mucosa of the lower lip&#46; The patient reported that they had been there for years but were asymptomatic &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; Under gentle pressure&#44; they released a transparent gelatinous material through the ostium &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; Dermoscopy revealed round cup-shaped structures with a more erythematous center and a double vascular pattern comprising fine peripheral hairpin vessels and rosary bead&#8211;shaped vessels in the shape of a fingerprint &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; Analysis of a skin biopsy specimen revealed acanthotic mucosa with parakeratotic hyperkeratosis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41; and minor salivary gland tissue with ductal dilatation and squamous metaplasia &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46; Abundant plasma cells were observed in the glandular interstitium &#40;CD138<span class="elsevierStyleSup">&#43;</span>&#41;&#44; with absence of light chain restriction&#44; thus ruling out hematologic neoplasia &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>C&#41;&#46; Compact material was visible inside the lumen&#44; extending toward the surface&#46; Periodic acid-Schiff staining was positive &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>D&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Diagnosis&#58; Glandular Cheilitis</span><p id="par0010" class="elsevierStylePara elsevierViewall">Glandular cheilitis &#40;or cheilitis glandularis&#41; has received little attention in the medical literature&#46; First reported by von Volkman in 1879&#44; it is a chronic&#44; persistent disorder characterized by hyperplasia and inflammation of the salivary glands in the lips and may or may not occur with actinic cheilitis&#46; It mainly affects the lower lip&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The excretory ducts appear dilated and inflamed and are seen as red and dotted mucosal macules&#46; The volume of the lip may be increased &#40;macrocheilia and eclabium&#41; in deep and suppurative forms &#40;apostematosa&#41;&#44; although the simple or superficial form &#40;as we describe here&#41; seems to be more common&#46; The simple variant may be characterized by superficial erosions and crusts&#44; whereas the deep variant may involve scarring&#46; This condition is more common in men&#44; and its etiology is unclear&#46; Associated risk factors include chronic actinic damage&#44; smoking&#44; injury&#44; thick saliva production&#44; bacterial infections&#44; and deficient oral hygiene&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#8211;4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Diagnosis is based on clinical findings&#44; although histopathology&#44; while not specific&#44; can prove extremely useful for identifying end-stage inflamed&#44; hyperplastic&#44; atrophic salivary glands&#44; as well as ductal metaplasia and ectasia&#46; The differential diagnosis includes actinic cheilitis&#44; irritant or allergic contact cheilitis&#44; atopic cheilitis&#44; lichen planus&#44; sarcoidosis&#44; granulomatous cheilitis&#44; and actinic pruritus&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Treatment is varied and includes observation and photoprotection&#44; antibiotic therapy&#44; cryotherapy&#44; corticosteroids administered topically or as an infiltration&#44; and vermilionectomy&#44; which is the most effective approach in patients with chronic and suppurative forms&#46; Some authors consider this entity to be premalignant and&#44; therefore&#44; that it requires active treatment&#46; Indeed&#44; glandular cheilitis shares some etiologic and pathogenic factors with actinic cheilitis&#44; although this has never been demonstrated&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In the present case&#44; the clinical manifestations and histopathology findings were consistent with glandular cheilitis&#46; The patient was asymptomatic and preferred to avoid invasive treatments&#46; Therefore&#44; we opted for a conservative approach involving the suppression of predisposing factors&#44; rigorous photoprotection&#44; and close monitoring&#44; which&#44; moreover&#44; was necessary owing to the patient&#39;s history of skin cancer&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> Glandular cheilitis is infrequently reported and probably underdiagnosed&#44; and its dermoscopic characteristics have not been discussed to date&#46; We report a case in which the lesions were very striking&#46; Health professionals should become aware of this condition given its role as an indirect marker of chronic actinic damage of the lip and&#44; therefore&#44; the associated increased risk of neoplasm&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of Interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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