The lips should be examined for symmetry and tissue consistency and texture. Normally the lip tissue should be resilient, smooth and have a homogenous pink color (Figure 8). The vermillion border should be distinct and even. Early ultra violet damage may present as an indistinct or broken vermillion border with color variations or white blotches within the lip tissue. More advanced signs of damage include induration, pitting and ulceration of the tissues. Patients with the very early signs of damage should be shown the area and advised to limit exposure to the sun and use a lip balm with a sunscreen. They should be advised about the signs and appearance of more serious changes. Patients should monitor their lips for evidence of these changes. The commissures should be clear of lesions and should not show signs of cracking or dryness (Figure 9).
Common pathological conditions which affect the commissures include angular cheilitis, Candida Albicans, nutritional deficiencies, and Human Herpes Virus 1 or 2 lesions. The lips may also be affected by lesions associated with contact dermatitis or allergic reactions to food, cosmetics, lip balms, flavoring agents, dental products such as toothpaste, and other environmental substances. Habits such as lip chewing, biting the lips, and licking the lips may result in chapping and abrasion of the delicate tissues of the lips and the surrounding skin. It is often difficult to diagnose and to manage these lesions and patients may find it very difficult to break the long-term habits causing them.