LIP, FACE, VESTIBULE David E. Wojtowicz, DDS, MBA

LIPLIP l WHITE l RED l ULCER l WHITE l RED l ULCER l EXOPHY- TIC l DEVELOP- MENTAL l EXOPHY- TIC l DEVELOP- MENTAL

LIP WHITE l Candidiasis l Squamous Cell Carcinoma l Actinic Cheilitis l Smoker’s Keratosis l Candidiasis l Squamous Cell Carcinoma l Actinic Cheilitis l Smoker’s Keratosis

LIP RED & PIGMENTED l Angular Cheilitis (= Perleche) Commissure l Hemangioma l Labial Melanotic Macule (=Ephelis) l Angular Cheilitis (= Perleche) Commissure l Hemangioma l Labial Melanotic Macule (=Ephelis)

LIP ULCERS l Traumatic l Herpetic l Erythema Multiforme –Hypersensitivity (Herpes, Sulfa) Reaction of Skin (Bull’s Eye) and Mucosa (Ulceration) l Traumatic l Herpetic l Erythema Multiforme –Hypersensitivity (Herpes, Sulfa) Reaction of Skin (Bull’s Eye) and Mucosa (Ulceration)

LIP EXOPHYTIC / ELEVATED l Fibroma l Papilloma l Mucocele l Angioedema l Fibroma l Papilloma l Mucocele l Angioedema

LIP DEVELOPMENTAL l Commisural Lip Pit

BUCCAL AND LABIAL VESTIBULE l White l Red l Ulcer l Anatomy l White l Red l Ulcer l Anatomy

VESTIBULE WHITE l Linea Alba l Cheek Bite l Snuff Dipper’s l Aspirin Burn l Linea Alba l Cheek Bite l Snuff Dipper’s l Aspirin Burn l Leukoedema l White Sponge Nevus l Lichen Planus l SCC l Fordyce’s Granules l Leukoedema l White Sponge Nevus l Lichen Planus l SCC l Fordyce’s Granules

VESTIBULE WHITE l Linea Alba l Cheek Bite l Snuff Dipper’s l Aspirin Burn l Leukoedema l White Sponge Nevus l Lichen Planus l SCC l Fordyce’s Granules l Linea Alba l Cheek Bite l Snuff Dipper’s l Aspirin Burn l Leukoedema l White Sponge Nevus l Lichen Planus l SCC l Fordyce’s Granules

VESTIBULE EXOPHYTIC l Stensen’s Papilla l Parulis l Stensen’s Papilla l Parulis

VESTIBULE RED / PIGMENTED l Erosive Lichen Planus l Amalgam Tattoo l Erosive Lichen Planus l Amalgam Tattoo

VESTIBULE ULCER l Apthous l Traumatic l Apthous l Traumatic

DERMATOLOGIC LESIONS l Actinic Keratosis l S C C l Keratoacanthoma l Basal C C l Actinic Keratosis l S C C l Keratoacanthoma l Basal C C l Systemic Lupus l Rosacea l Herpes Zoster l Nevus l Melanoma l Neurofibroma l Systemic Lupus l Rosacea l Herpes Zoster l Nevus l Melanoma l Neurofibroma l Seborrheic Keratosis l Senile Sebaceous Hyperplasia l Trichoepithelioma l Syringoma l Sebaceous Cyst l Epidermal Cyst

DERMATOLOGIC LESIONS LIST l Actinic Keratosis l S C C l Keratoacanthoma l Basal C C l Seborrheic Keratosis l Sebaceous Hyperplasia l Trichoepithelioma l Syringoma l Sebaceous Cyst l Epidermoid Cyst l Milia l Systemic Lupus l Rosacea l Herpes Zoster l Nevus l Melanoma l Neurofibroma l Actinic Keratosis l S C C l Keratoacanthoma l Basal C C l Seborrheic Keratosis l Sebaceous Hyperplasia l Trichoepithelioma l Syringoma l Sebaceous Cyst l Epidermoid Cyst l Milia l Systemic Lupus l Rosacea l Herpes Zoster l Nevus l Melanoma l Neurofibroma

ACTINIC KERATOSIS l Sun Damaged Skin l Scaling, Kertotic, & Erythematous l Appears Gray to Deep Brown l Premalignant l Sun Damaged Skin l Scaling, Kertotic, & Erythematous l Appears Gray to Deep Brown l Premalignant

S C C l Resembles B C C –Enlarging Ulceration –Central Crust –Indurated Base l Regional & Distant Metastasis l M > F l Resembles B C C –Enlarging Ulceration –Central Crust –Indurated Base l Regional & Distant Metastasis l M > F

KERATOACANTHOMAKERATOACANTHOMA l Resembles S C C l “Self Healing Carcinoma” l Pink Dome > Keratin Plug > Crater >Healing l May Exhibit Aggressive Destruction of Tissue l Resembles S C C l “Self Healing Carcinoma” l Pink Dome > Keratin Plug > Crater >Healing l May Exhibit Aggressive Destruction of Tissue

BASAL C C l Nodulo Ulcerative: Translucent Papule >Enlarges Slowly > Central Depression >Firm Border >Ulcerates l Men >40 l Nodulo Ulcerative: Translucent Papule >Enlarges Slowly > Central Depression >Firm Border >Ulcerates l Men >40

SEBORRHEIC KERATOSIS l Elevated, Verrucous l Brown, Black, Greasy l “Stuck On” l Older Individuals l Elevated, Verrucous l Brown, Black, Greasy l “Stuck On” l Older Individuals

SEBACEOUS HYPERPLASIA l Elevated l Soft l Flesh or Yellow Color l Central Punctum l Forehead l Middle Age l Elevated l Soft l Flesh or Yellow Color l Central Punctum l Forehead l Middle Age

TRICHOEPITHELIOMATRICHOEPITHELIOMA l Hair Follicle Lesion on Upper Face l Flesh-Colored Papule l Dome-Shaped l Adjacent to Nose l Hair Follicle Lesion on Upper Face l Flesh-Colored Papule l Dome-Shaped l Adjacent to Nose

SYRINGOMASYRINGOMA l Multiple Papules –Pebble Like l Flesh or Yellow Color l Upper & Lower Eyelids l Adenoma of Sweat Ducts l Onset in Adolescence l Multiple Papules –Pebble Like l Flesh or Yellow Color l Upper & Lower Eyelids l Adenoma of Sweat Ducts l Onset in Adolescence

SEBACEOUS CYST l Dome Shaped l Superficial l Hair Bearing Area l Slow Growing l Surgical Removal l Dome Shaped l Superficial l Hair Bearing Area l Slow Growing l Surgical Removal

EPIDERMOID CYST l Follicular Cyst (Hair Follicle) l Elevated, Firm l Central Pore l Thick Keratinous Contents l Slow Growing l cm l Follicular Cyst (Hair Follicle) l Elevated, Firm l Central Pore l Thick Keratinous Contents l Slow Growing l cm

MILIAMILIA l Tiny Epidermoid Cysts (1 - 2 mm) l Contains Keratin l Around Eyes l Tiny Epidermoid Cysts (1 - 2 mm) l Contains Keratin l Around Eyes

SYSTEMIC LUPUS l Butterfly Rash

ROSACEAROSACEA l Erythema of “Flush Area” l Chronic Acne l Mimics Lupus l F > M, 20 to 60 Years l Erythema of “Flush Area” l Chronic Acne l Mimics Lupus l F > M, 20 to 60 Years

HERPES ZOSTER l Vesicles > Erythema > Crust l Unilateral Distribution Along Innervation l Vesicles > Erythema > Crust l Unilateral Distribution Along Innervation