Differential Diagnosis for Lip Lesion

Given the information that the lesion is located in the middle of the lips and is not angular cheilitis, we can consider the following differential diagnoses:

• Single Most Likely Diagnosis
  • Actinic cheilitis: This condition is a precursor to squamous cell carcinoma and is often seen on the lower lip, especially in individuals with significant sun exposure. It presents as a diffuse, atrophic, or erosive lesion, which could be in the middle of the lip.
• Other Likely Diagnoses
  • Fordyce spots: These are small, yellowish or white bumps on the lips that represent ectopic sebaceous glands. They can appear anywhere on the lips, including the middle.
  • Mucocele: A mucous cyst that can occur on the lips, often resulting from trauma to a minor salivary gland. It can appear as a single, painless, translucent lesion in the middle of the lip.
  • Herpes simplex virus (HSV) infection: Although typically seen at the vermilion border, HSV can occasionally cause lesions on the inner aspect of the lips, especially if the individual has a habit of licking or biting the area.
• Do Not Miss Diagnoses
  • Squamous cell carcinoma (SCC): While less common than actinic cheilitis, SCC is a critical diagnosis to consider due to its potential for malignancy. Any persistent, non-healing lesion on the lip should raise suspicion for SCC.
  • Syphilis (secondary): Syphilis can cause a wide range of oral manifestations, including mucous patches on the lips. Although less common, it's crucial to consider in the differential due to the importance of early diagnosis and treatment.
• Rare Diagnoses
  • Granuloma faciale: A rare, benign condition that can cause single or multiple lesions on the face, including the lips. It's more commonly seen on the forehead, cheeks, or nose but can occasionally affect the lips.
  • Cheilitis glandularis: A rare condition characterized by inflammation of the minor salivary glands in the lips, leading to swelling and sometimes ulceration. It's an uncommon diagnosis but should be considered in cases of chronic lip lesions.