Which developmental condition carries an INCREASED risk of squamous cell carcinoma?

Correct answer: A. Cheilitis glandularis

• A. CORRECT. CHEILITIS GLANDULARIS is a chronic condition of the LOWER LIP in which the minor salivary glands are enlarged and inflamed, the ductal orifices are dilated and patulous, and mucus or mucopurulent material can be expressed from them. The lip becomes everted, thickened and chronically exposed. Reported rates of associated squamous cell carcinoma range widely, but the association is real and is usually attributed to the combination of chronic inflammation and the marked ACTINIC exposure of an everted lower lip. Vermilionectomy ('lip shave') is sometimes performed.
• B. Heck disease is a benign HPV-13/32-associated multifocal epithelial hyperplasia producing soft, flat-topped papules on the labial and buccal mucosa, common in certain indigenous populations. These are LOW-RISK HPV types with no malignant potential; lesions often regress spontaneously.
• C. Cheilitis granulomatosa (Miescher cheilitis) is persistent non-tender lip swelling from non-caseating granulomatous inflammation. With facial palsy and fissured tongue it forms Melkersson-Rosenthal syndrome. It may herald Crohn disease or sarcoidosis, but it is not premalignant.
• D. Gingival fibromatosis is a benign fibrous overgrowth, either hereditary or drug-induced (phenytoin, cyclosporine, nifedipine). It causes functional and aesthetic problems and delayed eruption, but has no malignant potential.

Note: Don't confuse cheilitis GLANDULARIS with ACTINIC cheilosis. Actinic cheilosis is the far more commonly tested premalignant lower lip lesion — a blurred vermilion border with atrophy, scaling and mottling in an outdoor worker, and it is a genuine precursor of lip SCC.