From the Guidelines
Cheilosis in cancer patients should be managed by addressing the underlying cause, which may include nutritional deficiencies, fungal infections, or cancer treatment side effects, to improve morbidity, mortality, and quality of life.
Causes and Risk Factors
Cheilosis, characterized by cracks and inflammation at the corners of the mouth, can occur in cancer patients due to several factors, including cancer treatments like chemotherapy and radiation therapy that can cause nutritional deficiencies, particularly B vitamins (especially riboflavin, B6, and B12) and iron, which are common causes of cheilosis 1. Additionally, cancer-related immunosuppression may lead to fungal infections (candidiasis) that manifest as cheilosis.
Treatment and Management
Treatment typically involves addressing the underlying cause with nutritional supplementation (B-complex vitamins at standard daily doses), topical antifungal medications like nystatin or clotrimazole applied 3-4 times daily for 7-14 days if fungal infection is present, and maintaining good oral hygiene 1. For symptomatic relief, petroleum jelly or zinc oxide ointment can be applied to affected areas several times daily. Cancer patients should stay well-hydrated and maintain adequate nutrition, possibly with the help of a dietitian.
Importance of Early Detection and Screening
It is also important to note that while cheilosis itself is not a direct indicator of oral cancer, the risk factors for cheilosis, such as immunosuppression and nutritional deficiencies, can also increase the risk of oral cancer. Therefore, cancer patients with cheilosis should be screened for oral cancer as part of their routine care, using a systematic clinical examination of the oral cavity, as recommended by the US Preventive Services Task Force 1.
Key Considerations
- Cancer patients with cheilosis should be evaluated for underlying nutritional deficiencies and fungal infections.
- Treatment should be tailored to the underlying cause, with a focus on nutritional supplementation, antifungal therapy, and good oral hygiene.
- Cancer patients should be screened for oral cancer as part of their routine care, using a systematic clinical examination of the oral cavity.
From the Research
Cheilosis and Cancer
- Cheilosis, or inflammation of the lips, can be associated with various etiologies, including irritant and allergic contact dermatitis, atopic cheilitis, actinic cheilitis, infectious etiologies, nutritional deficiencies, drug-induced cheilitis, and rare etiologies 2.
- Chronic actinic cheilitis is a potentially malignant condition that requires biopsies to exclude severe dysplasia or carcinoma 3.
- There is no direct evidence linking cheilosis to cancer, but some studies suggest that certain conditions, such as actinic cheilitis, can increase the risk of developing cancer 3.
- Vitamin B12 levels have been associated with outcomes in patients with cancer treated with immunotherapy, with elevated levels being a negative predictor for overall survival and progression-free survival 4.
Types of Cheilosis
- Angular cheilitis can occur spontaneously but is frequently related to several precipitating factors, such as systemic immune suppression, local irritation and moisture, fungal and/or bacterial infection 5, 3.
- Actinic cheilitis occurs mostly in middle-aged, fair-skinned men and is a potentially malignant condition 3.
- Cheilitis can also be seen in various systemic conditions, such as lichen planus, lupus, atopic dermatitis, and nutritional deficiencies 3.
Diagnosis and Treatment
- Distinguishing among the various etiologies of cheilitis is clinically difficult, as many causes may produce similar erythema and superficial desquamation of mucosal skin 2.
- A diagnostic algorithm is needed to assist clinicians in the management of cheilitis, including extensive testing and treatment trials 2.
- Treatment options for cheilitis include antifungals, topical treatments, occlusal vertical dimension restoration, B-vitamin supplementation, anti-drooling prosthetic device, and photodynamic therapy 5.