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.
