Introduction

Cancer is a scary topic. Whether it's a suspicion or a confirmed diagnosis for you or someone you love, there is a lot to think about.  

Cancer can affect any part of your body, including your lip. When it occurs around your mouth, it is grouped as an oral cancer. Unlike other areas of your body, which may be hard to check, when something is on or around your lips, it's hard to ignore. As this prompts an investigation, it can be quickly diagnosed and cured, giving lip cancer a high survival rate. 

Treatment for lip cancer can involve surgery, chemotherapy or radiotherapy.¹

If you’re ever worried about a new mark, scab, bump or general changes to your skin, then don’t hesitate to seek help. It could be any number of things, but the sooner you treat it, the better it will be for you. 

Diagnosing is a complicated task, especially if there’s similarity in symptoms between different conditions. This article will cover some conditions that mimic lip cancer, potentially complicating diagnosis.

What does lip cancer look like?

Typical symptoms and signs include:

• Spots that look like cold sores and do not go away
• Spot on your lips that may be raised
• Pain, lack of feeling or tingling around the area
• Wobbling teeth
• Changes to the size of lips (may get thicker)
• Bleeding of the lips
• Swelling around the lips
• Changes to the texture of the lips¹

What are the risk factors for lip cancer? 

• Tobacco - regardless of the form, whether you're smoking it or chewing it
• Alcohol 
• Sunlight and tanning beds
• Having fair skin
• Age - most prevalent in people aged 50 - 60 years old
• Males are 3 times more likely to get lip cancer
• Weak immune system

Non-cancerous conditions that can mimic lip cancer

Actinic cheilitis

• It can turn into cancer
• Causes changes to the colour and texture of the lips
• Lips look cracked, rough, scaly
• Usually painless, but can cause numbness and tenderness
• Regular checkups are important to ensure it does not turn into cancers²

Angular cheilitis

• Inflammation and irritated, cracked skin at the lip corners
• Dry skin causes cracks in the skin, which open up and may get infected
• Symptoms include bleeding, blisters, crusting, and light-coloured skin
• Common in immunocompromised, very young or elderly³

Mucoceles

• Harmless mucous-filled cysts that occur due to minor trauma to the salivary glands in your mouth
• They look smooth, like a pimple, but may have a blue tint to the skin
• Usually appear on the inside of your bottom lip, but can also affect your tongue, gums, cheeks, and the bottom of your mouth
• Not usually painful⁴

Lichen planus

• A long-term inflammatory condition that can affect your whole body, including the inside of your mouth
• Symptoms include tiny dots growing all over the skin, and white dots in your mouth, cheeks and lips
• Painless but itchy⁵

Herpes simplex virus (HSV) infections

• It can affect different parts of the body, including the mouth and genitals
• Causes pus-filled blisters which burst, then crust over into cold sores 
• Skin may tingle or itch before the blisters appear
• Highly contagious, spreading through direct contact with another infected person's skin
• Does not completely go away, but may have periods without symptoms⁶

Cancerous conditions to consider

Basal cell carcinoma (BCC)

• The most common form of skin cancer has a high cure rate, especially when caught early
• Can look like open wounds, be red or pink colored, shiny bumps, scars or raised skin
• May be crusty, itchy, bleed or have pus coming out of it
• It patients with darker skin, it may look like a mole in patients with darker skin.
• Often starts in areas of the body exposed to the sun⁷

Melanoma

• The most dangerous type of skin cancer
• Treatable if caught early
• Asymmetrical shape, uneven borders, uneven colour
• Changes size, shape and colour
• Rare on lips, but dangerous if overlooked⁸

Verrucous carcinoma

• Uncommon but treatable cancer
• Usually occurs inside the mouth, but can also occur on other parts of the body, such as the genitals
• Red or white patches in your mouth
• Wart-like appearance may cause misidentification⁹

Leukoplakia/erythroplakia

• Red spots with or without white patches
• May be pre-cancerous or harmless - a biopsy will confirm
• Affects soft tissue, including cheeks, tongue, floor of your mouth and throat¹⁰
  

Infectious and inflammatory conditions that can mimic lip cancer

Syphilitic chancre

• An infection caught from someone else who has it
• Starts as a smooth sore on the lips (but can also affect genitals or mouth)
• Other symptoms may include a rash, fever, muscle pain or sore throat
• Treated with antibiotics¹¹

Tuberculosis

• Tuberculosis is a contagious infection
• Rarely can present with ulcers that are painless with uneven borders and do not heal
• Lips, inside of your mouth, tonsils, gums and tongue may also be affected
• A biopsy of the ulcer can diagnose whether it is an infection or cancerous

Crohn’s disease

• This is inflammation in your digestive system
• Can cause lip swelling, cuts and ulcers, but common symptoms include diarrhoea, bloody stools, stomach pain and weight loss
• No current cure, but symptoms can be managed with medication¹²

Diagnosing lip cancer

Lip cancer can be easily mistaken for different conditions, some of which are mentioned above. If you’ve got a persistent mark on your lip that you’re not sure how it came and isn’t getting better, then don’t hesitate to see your doctor for a diagnosis. They may ask you questions such as how long you’ve had it, what it feels like (eg. is it painful), if you know what caused it, if you’ve had recent infections, or recent trauma to the area.  

Your doctor will probably also want to physically check it, paying particular attention to:

• What part of your lip is it on
• Whether it has occurred on any other parts of your body
• What does the texture feel like (i.e is it rough, hard or smooth)
• What colour is it 
• What size is it
• Whether any of the characteristics (size, texture, colour, shape) are changing

Tools or procedures to help with the diagnosis may include:

1. A biopsy - this involves taking part of the sore and testing it to confirm what it is. It is an accurate procedure, often named as the “gold standard” for diagnosing
2. Imaging - scans may be taken to have a look at deeper layers of the sore
3. Lab tests - e.g., for infections like Herpes Virus or Syphilis

The different tests and diagnoses may take time, as different conditions have similar/ overlapping symptoms. Cancer is a difficult topic to think about, but remember, lip cancer has a high cure rate, and the earlier it is diagnosed, the faster accurate treatment can be initiated, and support is always available.

Summary

Lip cancer can resemble several other conditions, making diagnosis challenging. Typical signs include persistent sores, swelling, bleeding, texture or colour changes of the lips. Risk factors include tobacco, alcohol, sun exposure, fair skin, older age, and weak immunity.

Non-cancerous mimics include actinic cheilitis, angular cheilitis, mucoceles, lichen planus, and herpes simplex infections. Other cancers that may appear similar are basal cell carcinoma, melanoma, verrucous carcinoma, and leukoplakia/erythroplakia. Infectious or inflammatory disorders like syphilis, tuberculosis, and Crohn’s disease can also cause lip lesions.

Diagnosis requires a detailed history, physical examination, and often a biopsy (gold standard), along with imaging or lab tests. While many conditions can look alike, early detection of lip cancer is crucial since it has a high cure rate when treated promptly.