At a Glance: Oral herpes simplex vs SCC of the lip

SCC
SCC

Herpes Simplex Labialis

Clinical features

  • Initial itching or burning at the site.
  • Followed by groups of vesicles on an erythematous base.
  • May ulcerate, scab over.
  • Heals, usually without scarring.
  • Patient may feel unwell and have enlargement of the local lymph glands.

Management

  • A clinical diagnosis but if in doubt can take a swab for culture.
  • Self-limiting condition usually resolves in 7-10 days.
  • Mild cases may not require treatment.
  • Early topical aciclovir cream in the prodromal phase may abort attacks.
  • Systemic antiviral drugs may be considered if complications or frequent recurrences.

Squamous carcinoma of the lip

Clinical features

  • Often arises in areas of previous solar keratosis.
  • Usually affects the lower lip.
  • Presents as a slow growing, warty tumour or a sore or ulcer on the lip that fails to heal.
  • May lead to involvement of submandibular or jugular glands.

Management

  • Any ulcer on the lip that persists for more than three weeks should be investigated.
  • Biopsy of the lesion.
  • Check for lymph node involvement.
  • Surgical excision of invasive lesions.
  • Radiotherapy if the patient is unable to undergo surgery.
  • For precancerous lesions, 5-fluorouracil or imiquimod, cryotherapy, or curettage and cautery.
  • Where there is a risk of metastatic spread, surgical excision of the lesion and appropriate lymph nodes is appropriate.
  • Avoid further sun exposure, and advise use of sunscreen.

Contributed by Dr Jean Watkins, a GP locum in Hampshire.

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