Basal growth patterns in actinic cheilitis: a proposed classification and comparison with degrees of dysplasia

Resumen

Introduction: Actinic cheilitis (AC) is a potentially malignant disorder caused by intense and prolonged exposure to ultraviolet radiation. This study aimed to analyze the clinical and histopathological features of actinic cheilitis, as well as to evaluate the degrees of dysplasia by the World Health Organization (WHO) system, the Kujan binary system, and for the first time, the basal growth pattern (Schmitz grading system). Methods: Fifty-nine cases of actinic cheilitis were analyzed, with clinical data obtained from archived biopsy request forms. Histological specimens were assessed to determine the degree of dysplasia, alongside evaluation of cytological and architectural alterations. Statistical comparisons were conducted using Chi-square test or Fisher's exact test (p < 0.05). Results: Histological grading according to the WHO system revealed a predominance of mild dysplasia (47.5%). The Kujan binary system classified most cases as low risk (86.4%), while the Schmitz grading system predominantly identified cases as grade II (60.8%). Statistically significant associations were observed between the WHO and Schmitz systems, as well as between the binary and Schmitz systems (p < 0.05). Additionally, an association was identified between the Schmitz system and the microscopic finding of epithelial projections in a drop pattern (p = 0.007). A significant correlation was also found between the binary and the WHO systems (p < 0.05). Conclusions: The Schmitz grading system appears to be a valuable tool for risk analysis in actinic cheilitis, effectively complementing established grading systems. Its straightforward application and simplicity enhance its practicality and reliability for evaluating these cases.