What could be causing a recurring bump on the center of my lip and how should it be treated?

Recurring Lip Bump: Diagnosis and Management

The most likely diagnosis for a recurring bump on the lip is a mucocele (mucous retention cyst), which should be managed with observation for small lesions or early surgical excision for persistent or cosmetically concerning lesions. 1, 2

Most Likely Diagnosis

Mucocele is the primary consideration for a recurring bump on the lip, particularly when located on the lower lip between the corner and center. 2 These lesions result from trauma to minor salivary glands, causing mucus extravasation into surrounding tissues. 3, 2

Key Diagnostic Features to Look For:

• Translucent or bluish dome-shaped swelling that fluctuates in size 2
• Painless unless traumatized, with occasional bleeding if the surface is disrupted 1
• Recurrent pattern of swelling, rupture, and reformation 2
• Location predominantly on lower lip where minor salivary glands are abundant 3
• History of lip biting or trauma (though not always present) 3, 2

Alternative Diagnoses to Consider

If You're Seeing a Child or Young Adult:

• Infantile hemangioma if the patient is an infant or young child, particularly if there's any bleeding history (41% of ulcerated hemangiomas bleed) 1
• Lobular capillary hemangioma (pyogenic granuloma) presents as a spontaneous, painless, bleeding mass 1, 2

If There's Active Bleeding:

• Traumatic lesion from friction or minor trauma causing minimal bleeding 1
• Ulcerated vascular lesion if bleeding is significant or recurrent 1

Other Possibilities:

• Fibroma from chronic irritation (appears as firm, flesh-colored nodule) 2, 4
• Papilloma if the surface appears warty or cauliflower-like 2

Management Algorithm

Step 1: Initial Assessment

• Examine the lesion characteristics: size, color (translucent/bluish suggests mucocele), consistency (soft and fluctuant), and whether it changes size 3, 2
• Palpate for firmness and assess associated lymph nodes (submandibular, submental, cervical) 3
• Document any bleeding history: duration >30 minutes or signs of hemodynamic instability require urgent evaluation 5

Step 2: Treatment Decision

For Small Mucoceles (<5mm) in Non-Cosmetically Sensitive Areas:

• Observation is appropriate as many resolve spontaneously 2
• Instruct patient to avoid lip biting and trauma 3
• Apply white soft paraffin ointment or lip balm to protect the area 5, 6

For Persistent, Large, or Cosmetically Concerning Mucoceles:

• Early surgical excision is recommended to prevent long-term pain, bleeding, and increased scarring 1
• Excision should include the affected minor salivary gland to prevent recurrence 2
• Use transverse mucosal incision at the junction of vermilion and vestibular mucosa to hide the scar 6

Step 3: Referral Indications

Refer to dermatology or oral surgery if:

• Lesion persists beyond 6-8 weeks despite conservative management 2
• Diagnostic uncertainty exists (firm consistency, pigmentation, rapid growth) 3, 2
• Significant bleeding occurs requiring intervention 1
• Multiple recurrences after attempted excision 2

Post-Treatment Care

• Lubricate lips with lip balm or cream to promote healing 6
• Maintain oral hygiene with soft toothbrush and mild fluoride toothpaste 6
• Avoid irritants: spicy foods, hot foods/drinks, and citrus fruits 6
• Use warm saline mouthwashes to gently clean without disrupting healing 5

Critical Red Flags Requiring Urgent Evaluation

• Bleeding duration >30 minutes or hemodynamic instability 5
• Rapid growth or change in character (suggests neoplasm) 3, 2
• Firm, fixed, or ulcerated lesion (consider squamous cell carcinoma, especially with sun exposure history) 7, 2
• Associated lymphadenopathy (suggests malignancy or infection) 3
• Feeding impairment in infants with perioral lesions 1

Common Pitfalls to Avoid

• Don't assume all recurring lip bumps are benign - always palpate for firmness and assess lymph nodes 3
• Don't perform incomplete excision of mucoceles - the affected salivary gland must be removed to prevent recurrence 2
• Don't ignore bleeding history - even minor bleeding can indicate vascular lesions requiring different management 1
• Don't delay biopsy if there's any diagnostic uncertainty, particularly in older patients or with atypical features 3, 2