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Lip lupus erythematosus

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Clinical record

A 40-year-old Indigenous Australian woman was referred to an outreach dermatology clinic in the Top End of the Northern Territory for assessment of painful lip ulceration of 2 years’ duration. She had been reviewed 16 months earlier in a distant regional centre, and a diagnosis of squamous cell carcinoma of the lip had been proposed. Skin biopsy had not been performed and the patient had refused a planned extensive surgical excision of the lip lesion at that assessment. Her general health was good.

Examination at the outreach clinic showed extensive and bilateral lower lip exophytic ulceration and crusting (Box 1). The upper lip and other cutaneous and oral surfaces were normal.

Lower lip skin biopsy samples were taken from the ulcer and adjacent lower lip mucosa to confirm a clinical diagnosis of lupus erythematosus and to exclude malignancy (Box 2). The hyperkeratotic squamous epithelium ranged from atrophic to acanthotic, with foci of lichenoid basal vacuolar damage resulting in squamous cell apoptosis and colloid bodies.

The submucosa contained a dense…