The prevalence of actinic cheilitis in farmers in a semi-arid northeastern region of Brazil

Clinicopathological Analysis of Actinic Cheilitis: A Systematic Review with Meta-analyses

BACKGROUND

This systematic review aimed to conduct a complete investigation of the demographic aspects, clinicopathological features, degrees of epithelial dysplasia, and malignant transformation rate of actinic cheilitis.

METHODS

The study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in the International Prospective Register of Systematic Reviews (CRD42020201254). A search without year and language restrictions was performed using PubMed/MEDLINE, Embase, Virtual Health Library, Scopus, Web of Science, and gray literature. Studies that provided information on patients with actinic cheilitis were included, excluding those with general information on other diseases or other types of cheilitis. Risk of bias was explored using the Joanna Briggs Institute tool. Narrative and quantitative data syntheses were performed using meta-analyses and subgroup analyses. Association tests were also performed.

RESULTS

Thirteen studies (728 patients) were included. The most prevalent clinical signs were dryness (99%), blurred demarcation between the lip vermilion and skin (82%), scaling (69%), and atrophy (69%). Regarding epithelial dysplasia, a prevalence of mild dysplasia (34.2%), followed by moderate (27.5%), and severe (14.9%). The malignant transformation rate was 14%. Crusts, ulcerations, and erythematous areas were associated with lip carcinoma (p < 0.001), and scaling was associated with actinic cheilitis (p < 0.001).

CONCLUSIONS

This study revealed several features of actinic cheilitis, providing an overview of the disease. It is suggested that new studies help develop policy guides for the standardization of clinical criteria, enabling more rigorous and homogeneous analysis of actinic cheilitis.

Sun Safety: Knowledge and Behavior among Egyptian Farmers-a Multicomponent Intervention Study

The purpose of study was to screen for health hazards related to sun exposure and to examine the effectiveness of a sun safety multicomponent intervention designed specifically for the Egyptian farmers. A multicomponent interventional study was conducted among 128 farmers from three villages in Zagazig district, Sharkia Governorate, Egypt, from January to July 2022. It passed through three phases: phase 1: assessment of participants' risk of skin cancer and vision screening; phase 2: filling a semi-structured questionnaire assessing sun exposure hazards and sun safety knowledge, behavior, and barriers; and phase 3: conducting multicomponent intervention composed of education session, providing sun safety supplies and reminders then evaluate the effect of this intervention after one month. Most of participants had moderate risk for skin cancer (69.0%), history of photokeratitis (77.3%), cataract (15.6%), and bad/very bad self-reported overall eyesight (43.0%). After intervention, there was a statistically significant improvement in the participants' awareness regarding sun exposure-related hazards, all knowledge items about sun safety measures (p < 0.01) and some sun safety behaviors (p < 0.05) including wearing protective clothing, minimization of direct sunlight exposure, taking breaks, plentiful water intake, regular self-checking of skin, wearing wide brimmed hats, and job rotation. Furthermore, there was a statistically significant improvement in all sun protection barriers (p < 0.01) except sunscreen and sunglasses related barriers (p ˃ 0.05). The multicomponent intervention composed of education session, providing sun safety supplies and reminders was effective in increasing awareness of farmers with sun exposure hazards and improving their knowledge and behavior towards sun safety measures.

Actinic cheilitis in rural workers: prevalence and associated factors

Objective

To evaluate the prevalence of actinic cheilitis in rural workers and factors associated with the development of this condition.

Methods

A cross-sectional study was conducted in a city in Northeastern Brazil. Data were collected by clinical examination and use of a questionnaire validated with 300 rural workers. The χ² test was employed to identify possible associations between the presence of actinic cheilitis and clinical and demographic variables. Multiple logistic regression analysis was performed using forward stepwise selection. A p value of 0.05 was considered significant.

Results

The prevalence of actinic cheilitis was 12.0% in the sample. The highest prevalence of actinic cheilitis was observed in white males, with low educational level, and an approximately 40-year history of sun exposure. Chronic lesions were commonly found in the lower lip and were characterized by scaling, dryness, and mild edema. Skin color, sex, educational level of patients, and cumulative sun exposure (in years), were identified as predictors of development of actinic cheilitis.

Conclusion

Our results suggest the need to implement educational health strategies aimed to orient the population about risk factors and preventive measures of the disease. Appropriate clinical management of patients with actinic cheilitis is important for prevention of lip cancer.

Social and behavioural associated factors of actinic cheilitis in rural workers

OBJECTIVE

This cross-sectional study aimed to evaluate the prevalence and factors potentially associated with the development of actinic cheilitis (AC) in Brazilian rural workers.

SUBJECTS AND METHODS

A professional performed all physical examinations and evaluations using semi-structured questionnaires in 240 rural workers.

RESULTS

Eighty-three participants were diagnosed with AC (34.6%). It was more prevalent among workers older than 45 years (3.29-10.96 95% IC; OR = 3.30; p = .0018), Caucasians (phototypes I and II) (4.78-16.12 95% IC; OR = 10.81; p < .0001), illiterate individuals (2.16-21.59 95% IC; OR = 10.43; p = .0037), those with 6 or fewer years of formal schooling (2.03-7.89 95% IC; OR = 4.63; p = .0013), those regularly using pesticides (1.58-6.64 95% IC; OR = 2.79; p = .0260) and those who used the private health service in their last appointment (1.17-3.54 95% IC; OR = 2.72; p = .0083).

CONCLUSION

There was a substantial prevalence of AC among rural workers with advanced age, white skin, and illiteracy, those with lower levels of education, those who regularly use pesticides, and those who utilised private health services in their last appointment. Thus, healthcare strategies that include rural workers are required for the control and prevention of AC in both public and private health services.

Demographic and Clinicopathologic Features of Actinic Cheilitis and Lip Squamous Cell Carcinoma: a Brazilian Multicentre Study

Data on the occurrence and clinicopathological characteristics of actinic cheilitis (AC) and lip squamous cell carcinoma (LSCC) are well studied; however, they are based on studies limited to a single centre. Herein, we described the frequency of AC and LSCC submitted to microscopic examination from representative geographic regions of Brazil. A retrospective multicentre study was performed on biopsies obtained from 1953 to 2018 at 10 Brazilian oral and maxillofacial pathology centres. A total of 198,709 biopsy specimens were surveyed. Sociodemographic data and clinicopathologic characteristics were analysed. A total of 2017 cases of ACs (1.0%) and 850 cases of LSCCs (0.4%) were recorded. A strong fair-skinned (> 87%) male (> 70%) predilection was observed in both conditions. The mean age was 54.8 ± 18.7 for individuals with AC and 57.8 ± 19.0 for individuals with LSCC. The most commonly affected site was the lower lip (> 90%). This is a large multicentre study of AC and LSCC from Brazil. The frequency and clinicopathological features of AC and LSCC were similar to those described worldwide. This study provides robust and representative epidemiological data of these conditions for the scientific community.

Medical practitioners' educational competence about oral and oropharyngeal carcinoma: a systematic review and meta-analysis

Medical practitioners' (MP) role is pivotal in primary prevention, early diagnosis, prompt referral and effective management of oral and oropharyngeal carcinomas (OC/OPC), which raises the importance of their effective OC/OPC education at all levels of medical education. The purpose of this systematic review was to summarise the available scientific evidence about their educational competence in dealing with OC/OPC. We made a systematic search of papers in the English language in MEDLINE, Scopus, Cochrane Library CENTRAL and CINAHL databases from their inception until December 2018. Overall, 23 cross-sectional and three interventional studies have been selected for the systematic review and 18 of these were included in the meta-analyses. Excluding tobacco use (synthesised estimate of 95% of respondents identified tobacco as an OC/OPC risk factor, 95% CI of synthesised estimate 92% to 97%) and alcohol consumption (65%, 95%CI 52% to 77%), less than half of MP (approximately) were knowledgeable about important OC/OPC risk factors including human papilloma virus (42%, 95% CI 30% to 54%), poor diet (34%, 95% CI 17% to 54%), and advancing age (45%, 95% CI 21% to 70%). There was a low to moderate level of awareness among MP regarding common precancerous oral lesions involving leukoplakia (56%, 95% CI 32% to 79%), erythroplakia (30%, 95% CI 8% to 58%), and oral lichen planus (13%, 95% CI 0 to 41%). Moderate knowledge was also recorded about frequent sites of OC development involving the tongue (48%, 95% CI 33% to 64%) and floor of the mouth (37%, 95% CI 19% to 57%). Most MP enquired about tobacco use (86%, 95% CI 74% to 96%), and alcohol consumption (73%, 95% CI 47% to 94%) during history taking, and expressed willingness to be given supplementary OC/OPC education (78%, 95% CI 54% to 96%), as well. With regard to the incidence of intraoral screening, 27% of MP (95% CI 12% to 46%) make an intraoral examination as a routine. Interestingly, studies from each continent yielded significantly different outcomes to some research questions in the review. From the MP's perspective, clinical time restrictions and deficiencies in organised training were recognised as the main barriers towards their OC/OPC educational competence. The findings of this systematic review indicated the existence of deficiencies in knowledge and misconceptions, neglected preventive responsibilities, and associated barriers towards OC/OPC. A need for improved OC/OPC training at all levels of medical education is required to increase competence worldwide.

Fludroxycortide cream as an alternative therapy for actinic cheilitis

OBJECTIVES

The objective of the study is to assess, by clinical follow-up, the efficacy of the dermatological cream Fludroxycortide 0.125 mg/g (Drenison®) in the treatment of actinic cheilitis (AC).

MATERIAL AND METHODS

Twenty-three patients diagnosed with AC participated in the study. Fifteen were submitted to corticotherapy with Fludroxycortide, applied three times a day for up to 6 weeks, associated with lip sunscreen (LS) before sun exposure. In the control group of eight patients, only the use of LS was established. At each weekly return, a photographic record was made of the lesion. After treatment, images were evaluated and scores were assigned to verify clinical evolution. Also, patients treated with Fludroxycortide responded to a questionnaire, to assess drug tolerability and treatment satisfaction.

RESULTS

In the group treated with Fludroxycortide (n = 15), five patients showed total improvement, seven presented partial improvement, and three showed no clinical change. Concerning the patients treated with LS (n = 8), one presented total remission of the clinical lesion characteristics, four exhibited partial improvement, and three exhibited no clinical lip alteration. No case presented symptom worsening. Of the 15 patients undergoing corticotherapy, 12 were satisfied and reported that the product was not irritating and contributed to lesion improvement.

CONCLUSIONS

Conventional treatment with LS was effective in the remission of some AC lesions, but treatment responses were improved when associated with Fludroxycortide, especially in the more severe cases.

CLINICAL RELEVANCE

As it is a non-invasive therapy leading, in most cases, to adequate clinical results, safety, and tolerability, Fludroxycortide can be considered an effective alternative treatment for AC.

Differential Diagnosis of Cheilitis - How to Classify Cheilitis?

SUMMARY – Although cheilitis as a term describing lip inflammation has been identified and recognized for a long time, until now there have been no clear recommendations for its work-up and classification. The disease may appear as an isolated condition or as part of certain systemic diseases/conditions (such as anemia due to vitamin B₁₂ or iron deficiency) or local infections (e.g., herpes and oral candidiasis). Cheilitis can also be a symptom of a contact reaction to an irritant or allergen, or may be provoked by sun exposure (actinic cheilitis) or drug intake, especially retinoids. Generally, the forms most commonly reported in the literature are angular, contact (allergic and irritant), actinic, glandular, granulomatous, exfoliative and plasma cell cheilitis. However, variable nomenclature is used and subtypes are grouped and named differently. According to our experience and clinical practice, we suggest classification based on primary differences in the duration and etiology of individual groups of cheilitis, as follows: 1) mainly reversible (simplex, angular/infective, contact/eczematous, exfoliative, drug-related); 2) mainly irreversible (actinic, granulomatous, glandular, plasma cell); and 3) cheilitis connected to dermatoses and systemic diseases (lupus, lichen planus, pemphigus/pemphigoid group, angioedema, xerostomia, etc.).

Prevalence of and Factors Associated with Actinic Cheilitis in Extractive Mining Workers

Abstract The objective of the present study was to determine the prevalence of actinic cheilitis among extractive mining workers and factors associated with the condition, especially the relationship between clinical appearance and the length of occupational exposure to sunlight. A cross-sectional study was performed in Dona Inês, Paraíba, Brazil between 2014 and 2015. A clinical examination, clinical photography and a questionnaire were applied to 201 extractive mining workers. The T-student’s, ANOVA one-way, Fisher’s exact and Pearson chi-squared tests were performed and the significance level was set at 5%. A high prevalence of actinic cheilitis was observed (38.8%). Length of occupational exposure to sunlight in months (169.63±112.68, p=0.002) was associated with actinic cheilitis. Most workers were Caucasian (p<0.001) and aged 37.41±12.15 years (p=0.004). The time of occupational exposure to sunlight was significant in relation to the following clinical features: atrophy (225.75±97.31; p=0.024); blurred demarcation between the vermilion border of the lip and the skin (186.68±113.15; p=0.032); vertical fissures (210.09±123.07; p=0.046); white and red spotting (199.51±91.80; p=0.004); hard consistency of the lip (225.81±122.34; p=0.012). A high prevalence of actinic cheilitis was found. Age and ethnicity were associated with the presence of AC. Severe clinical presentations of actinic cheilitis were found among participants who had worked for at least 185 months (approximately 15 years) exposed to the sun.

Diclofenac sodium gel therapy as an alternative to actinic cheilitis

OBJECTIVE

Actinic cheilitis (AC) is a potentially malignant lesion caused by prolonged exposure to ultraviolet light. The aim of this research was to analyze the efficacy of diclofenac sodium 3% gel in the treatment of this condition, through clinical follow-up.

METHODS

Thirty-one patients diagnosed with AC were instructed to perform a topical application of the gel three times a day for a period of 90 days. In each visit, a digital photography was obtained for verified progress and response to treatment. Two researchers evaluated all images after treatment was completed and assigned the following scores regarding clinical aspect of the lip: 1, complete improvement; 2, partial improvement; 3, no changes; 4, worsening of the clinical condition. In addition, the patients' tolerability to the drug and their satisfaction after treatment were evaluated.

RESULTS

Twelve cases abandoned the treatment for reasons unrelated to the study. Ten participants showed total remission of all clinical features of the lesion and three had partial improvement of the characteristics. One participant presented worsening of clinical condition, and in five cases, treatment was discontinued due to development of mild adverse effects at the site of gel application. Regarding satisfaction analyses and tolerability to the drug, from 14 patients who completed treatment without adverse effects or complications, most agreed fully that they were satisfied with the therapy (n = 11) and that the drug was not irritating to the mouth (n = 9). Patients are being monitored without clinical signs of recurrence and/or progression of the lesions.

CONCLUSION

Topical application of the drug has provided a convenient and well tolerated in most cases.

CLINICAL RELEVANCE

Diclofenac sodium gel (3%) may be a promising alternative for treatment of actinic cheilitis.

The clinical prevalence of actinic cheilitis among community health agents from the regional V subprefecture of Fortaleza

ABSTRACT Objective: The aim of this study was to evaluate clinically the prevalence of Actinic Cheilitis in community health agents from the Regional V subprefecture of Fortaleza. Methods: The sample consisted of 333 community health workers exposed to the sun on a daily basis. The community health agents were evaluated through a questionnaire (with information about the individual, their occupations and habits) and a clinical examination in the first stage of the study. In the second stage, the Actinic Cheilitis lesions were classified according to the degree of severity, monitored and treated as needed. Both stages were performed by just one examiner. The data were tabulated in an Excel spreadsheet and evaluated by means of the G-test. Results: The results showed that the prevalence of Actinic Cheilitis was significantly associated with age, race / color and use of lip balm. A total of 101 (30.3%) community health agents were found to have normal labial mucosa, 195 (58.5%) had a mild alteration in Actinic Cheilitis, 34 (10.2%) with moderate Actinic Cheilitis and in 3 (0.9%) severe change was identified. Conclusion: The study concluded that the prevalence of Actinic Cheilitis is high among the community health agents from the Regional V subprefecture of Fortaleza.

Potentially malignant oral lesions: clinicopathological correlations

Objective

To determine the incidence of potentially malignant oral lesions, and evaluate and correlate their clinical and pathological aspects.

Methods

The sample consisted of cases clinically diagnosed as oral leukoplakia, oral erythroplakia, erythroleukoplakia, actinic cheilitis, and oral lichen planus treated at a diagnostic center, between May 2012 and July 2013. Statistical tests were conducted adopting a significance level of 5% (p≤0.05).

Results

Out of 340 patients, 106 (31.2%) had potentially malignant oral lesions; and 61 of these (17.9%) were submitted to biopsy. Actinic cheilitis was the most frequent lesion (37.5%) and the lower lip was the most affected site (49.6%). Among 106 patients in the sample, 48 (45.3%) reported nicotine consumption, 35 (33%) reported alcohol intake and 34 (32.1%) sun exposure while working. When clinical and histopathological diagnoses were compared, oral erythroplakia and atypical ulcer were the lesions that exhibited greater compatibility (100% each).

Conclusion

In most cases, clinical and histopathological diagnoses were compatible. An association between the occurrence of erythroplakia, leukoplakia and erythroleukoplakia with smoking was observed. Similarly, an association between actinic cheilitis and sun exposure was noted. Erythroleukoplakia presented the highest malignancy grade in this study. Finally, dental surgeons should draw special attention to diagnosis of potentially malignant oral lesions, choose the best management, and control the lesions to avoid their malignant transformation.

Clinicopathological profile and management of 161 cases of actinic cheilitis

BACKGROUND

Actinic cheilitis (AC) is a potentially malignant disorder of the lip caused by chronic exposure to ultraviolet radiation from the sun.

OBJECTIVES

To evaluate the clinical, demographic, morphological and therapeutic management in AC cases data associating to the histopathological grading.

METHODS

Demographic, clinical and management data of 161 patients with AC were analyzed. In biopsied cases, two calibrated examiners performed histopathological grading by binary system.

RESULTS

There was a prevalence of males (79.5%), aged 40 years or older (77.5%), light-skinned (85.7%), experiencing occupational exposure to sunlight (80.3%), with AC presenting clinically as white lesions (33.6%). Conservative treatment was adopted in 78 cases and biopsy in 83 cases (60.2% graded as low-risk AC). There were no significant associations between histopathological grading and gender (p= 0.509), age (p=0.416), ethnicity (p=0.388), occupational exposure to sunlight (p=1.000) or clinical presentation (p=0.803).

CONCLUSION

This study reinforces the hypothesis that demographic and clinical characteristics of AC are not related to histopathological grading. Advice on protection from sun exposure should be encouraged to avoid progression of AC and invasive therapies.

Precancerous lesions of oral mucosa

Precancerous lesions of oral mucosa, known as potentially malignant disorders in recent years, are consists of a group of diseases, which should be diagnosed in the early stage. Oral leukoplakia, oral submucous fibrosis, and oral erythroplakia are the most common oral mucosal diseases that have a very high malignant transformation rate. Oral lichen planus is one of the potentially malignant disorders that may be seen in six different subtypes including papular, reticular, plaque-like, atrophic, erosive, and bullous type, clinically. Atrophic and erosive subtypes have the greater increased malignant transformation risk compared to another subtypes. Although there are various etiological studies, the etiology of almost all these diseases is not fully understood. Geographically, etiologic factors may vary. The most frequently reported possible factors are tobacco use, alcohol drinking, chewing of betel quid containing areca nut, and solar rays. Early diagnosis is very important and can be lifesaving, because in late stages, they may be progressed to severe dysplasia and even carcinoma in situ and/or squamous cell carcinoma. For most diseases, treatment results are not satisfactory in spite of miscellaneous therapies. While at the forefront of surgical intervention, topical and systemic treatment alternatives such as corticosteroids, calcineurin inhibitors, and retinoids are widely used.

Gender in occupational health research of farmworkers: a systematic review

Background

Farmwork is one of the most hazardous occupations for men and women. Research suggests sex/gender shapes hazardous workplace exposures and outcomes for farmworkers. This paper reviews the occupational health literature on farmworkers, assessing how gender is treated and interpreted in exposure-outcome studies.

Methods

The paper evaluates peer-reviewed articles on men and women farmworkers' health published between 2000 and 2012 in PubMed or SCOPUS. Articles were identified and analyzed for approaches toward sampling, data analysis, and use of exposure indicators in relation to sex/gender.

Results

18% of articles reported on and interpreted sex/gender differences in health outcomes and exposures. Sex/gender dynamics often shaped health outcomes, yet adequate data was not collected on established sex/gender risk factors relating to study outcomes.

Conclusion

Research can better incorporate sex/gender analysis into design, analytical and interpretive approaches to better explore its mediation of health outcomes in light of emerging calls to mainstream gender research. Am. J. Ind. Med. 57:1344–1367, 2014. © 2014 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Queilite actínica: avaliação histopatológica de 44 casos

Objetivo: Descrever os aspectos epidemiológicos, clínicos e histopatológicos da queilite actínica. Material e método: Foi realizado um estudo retrospectivo a partir de casos com diagnóstico clínico de queilite actínica, registrados no arquivo histopatológico do Serviço de Cirurgia de Cabeça e Pescoço do Hospital Napoleão Laureano, Paraíba, relativos ao período de 2000 a 2007. Foram selecionados 44 blocos parafinados, que apresentavam condições de reavaliação histológica através da confecção de novas lâminas. Os novos cortes foram corados em Hematoxilina e Eosina, e a avaliação histopatológica foi realizada por dois examinadores independentes, sendo as alterações classificadas de acordo com OMS. Realizou-se análise estatística descritiva em programa SPSS for Windows versão 13. Resultado: Do total da amostra, 52,3% (23) dos casos foram diagnosticados em homens e 47,7% (21) em mulheres, com idade variando de 27 a 92 anos. A maioria dos indivíduos (81,9%) tinha mais de 40 anos. Em relação às características histológicas, 68,2% (30) dos casos exibiram algum grau de displasia epitelial, sendo 36,3% (16) classificados como displasia leve, 20,4% (9) como displasia moderada e 11,3% (5), displasia severa. Em 15,9% (7), ocorreu carcinoma de células escamosas. No tecido epitelial de revestimento labial, os achados histológicos mais frequentes e identificados foram presença de degeneração hidrópica (79,5%) e hipergranulose (56,8%). Infiltrado inflamatório foi observado em 88,6% dos casos e elastose solar, em 86,4%. Conclusão: Com base nos resultados da amostra estudada, podemos concluir que a maioria das lesões de queilite actínica acometeu lábio inferior de homens, com mais de 40 anos de idade. A análise histopatológica revelou displasia e atipia celular, infiltrado inflamatório e presença de elastose solar, que são características comuns em lesões de QA.

Prevalence of lip lesions in an Indian population

OBJECTIVES

Lip lesions are a frequent cause of consultation in dentistry, as they comprise a significant proportion of the oral lesions. The aim of the present study was to identify the different lip lesions and determine their prevalence in an Indian population.

MATERIAL AND METHODS

5231 patients visiting a Department of Oral Medicine and Radiology were examined for the presence of different lip lesions during the period from October, 2011 to May, 2013. The statistical analysis was done using Chi-square test and p<0.05 was considered to be statistically significant.

RESULTS

The age of the patients ranged from 8-70 years with a mean age of 32.6 years. The prevalence of lip lesions was 18.8%. The most commonly diagnosed lesions were those due to infections, which affected 32.6% of the population, followed by mucocele (29.8%) and premalignant lesions and conditions which were observed in 20.6% of the population. Males were more commonly affected than females.

CONCLUSIONS

The relatively high prevalence of the lip lesions suggests dental practitioners and health care workers to educate the patients and create more awareness regarding them. The dentists should have adequate knowledge about the etiology, clinical features, diagnosis and management of the lip lesions. Key words: Lip, lesions, India, prevalence.

Lesões maxilofaciais: um levantamento de 762 casos da Universidade Federal de Sergipe, Brasil

Introdução : A pesquisa epidemiológica de lesões maxilofaciais em determinada região estabelece as necessidades populacionais e orienta os profissionais da saúde na definição de ações preventivas e tratamento adequado. Objetivo: Analisar os laudos histopatológicos de lesões maxilofaciais do período de 1996 a 2011 do Laboratório de Patologia Oral do Departamento de Odontologia da Universidade Federal de Sergipe (UFS), Brasil. Material e método: Estudo retrospectivo das biópsias realizadas de 1996 a 2011, recuperando-se os dados referentes ao gênero e à idade dos pacientes, à localização das lesões e ao diagnóstico histopatológico. As lesões foram agrupadas em: neoplasias benignas, lesões potencialmente malignas, neoplasias malignas, lesões inflamatórias, lesões odontogênicas, lesões ósseas, lesões de glândulas salivares e anomalias de desenvolvimento. Resultado: Foram analisados 762 laudos, havendo maior prevalência das lesões inflamatórias (n=205, 26,9%). O diagnóstico mais comum entre as neoplasias benignas foi a lesão periférica de células gigantes (n=15); entre as lesões potencialmente malignas, foi a displasia epitelial (n=80), e entre as neoplasias malignas, foi o carcinoma de células escamosas (n=29). Dentre as lesões inflamatórias, a lesão mais prevalente foi a hiperplasia fibrosa inflamatória (n=74). O granuloma periapical (n=62) foi a lesão mais comum dentre as lesões odontogênicas. A lesão mais prevalente dentre as lesões ósseas foi o fibroma ossificante central (n=08); entre as lesões de glândulas salivares, foi o fenômeno de retenção de muco (n=64), e entre as anomalias de desenvolvimento, foi a mácula melanocítica (n=04). Conclusão: Os achados deste levantamento salientam a importância de planos de tratamento e medidas educativas que diminuam e previnam a exposição dos pacientes a fatores de risco.

Ki-67, TGF-β1, and elastin content are significantly altered in lip carcinogenesis

Epithelial changes observed in actinic cheilitis (AC) and lower lip squamous cell carcinoma (LLSCC) have been studied using different markers in order to observe diagnostic and prognostic factors for both lesions. The aim of the present study was to analyze Ki-67, TGF-β1, and elastin content in AC and LLSCC to determine the possible role of these proteins in lip carcinogenesis. Medical records of 29 cases of AC and 53 cases of LLSCC were analyzed. Lesions were classified according histological pattern and submitted to immunostaining for Ki-67, TGF-β1, and elastin. Different percentages of Ki-67-positive cells were found in AC depending on the degree of epithelial dysplasia (p < 0.01). An association was also found between the percentage of Ki-67-positive cells and tumor grade in LLSCC (p < 0.01). An inverse correlation was found between Ki-67 and TGF-β1 in AC and LLSCC (p < 0.01). Elastosis was thinner and more discontinuous in LLSCC in comparison to AC, and this difference in the elastin immunolabeling pattern was statistically significant between groups (p < 0.01). The present findings indicate that changes in Ki-67 and TGF-β1 content contribute to lip carcinogenesis. Furthermore, elastin content reflects changes in the extracellular matrix in both AC and LLSCC.

Spatial fuzzy c-means algorithm with adaptive fuzzy exponent selection for robust vermilion border detection in healthy and diseased lower lips

INTRODUCTION

Accurate lip contour identification is demanding since variations in color, form and surface texture, even in normal lips, introduce artifacts in non-adapted segmentation algorithms. Herein, a method for vermilion border detection and quantification in healthy and diseased lower lips is presented.

AIM

To quantify the morphological irregularities of lower lip border, to validate its discriminative power in solar cheilosis diagnosis and to provide supportive tools toward, cost effective, non invasive, disease monitoring.

MATERIALS

Segmentation algorithm for lower lip border was based on spatial fuzzy c-means clustering algorithm with adaptive selection of fuzzy exponent m. Lip features measuring morphological lip border deviations were estimated. The method of lip border extraction and quantitative description was evaluated in a gold standard set of 25 young volunteers without onset of lip diseases. Quantitative descriptors were evaluated in terms of correct classification rates in differentiating 30 healthy control cases from 41 patients with solar cheilosis and were further applied to quantify the therapeutic outcome after immunocryosurgery in eight patients with solar cheilosis.

RESULTS

Adaptive estimation of fuzzy exponent m substantially boosted the segmentation quality in gold standard cases yielding quite smooth lip contours and uniformly low values of lip irregularity features. Discriminant analysis highlighted the distance between the extracted and modeled vermilion border as a feature with excellent diagnostic accuracy (sensitivity and specificity 98% and 93% respectively). Results on patients with solar cheilosis followed up after treatment with immunocryosurgery showed that proposed quantitative lip marker was able to trace the improvement of disease after treatment.

CONCLUSION

Correct lip border recognition is the prerequisite for extracting essential morphological descriptors from lips with epithelial diseases like solar cheilosis. In this paper we presented an efficient method for the automatic identification and quantitative description of lower lip vermilion border morphology in health and disease using digital photography and image analysis techniques.