I have a bump near my upper lip

[Jackie]

I have a few questions concerning a small bump that I just noticed around my lip approximately a week ago.  First off let me give you a little of my medical background.  I am 28 years old and approximately 3 years ago I was diagnosed with actinic chelitis of the lower lip.  I was treated with Efudex on the lower lip for two weeks and then it was repeated the following year for two weeks.  Since that time I have lost some of the vermilion border around my upper and lower lip.  I visit my dermatologist approximately every four months and although I do have some chapping and loss of border he feels as though the Efudex has worked.  Now, I have this somewhat tender red bump that is small and scaly that has came up on the very edge of my upper lip (it is mainly around the white part, just the border goes into the red).  I guess I am concerned about this because of all the problems I have had with the actinic chelitis.  I saw my dermatologist and he said he thought it was just a stopped up oil gland considering the sudden on set of the bump.  He put me on some antibiotics in hopes that it would heal the lesion quicker. He said he would then do a 2 mm punch biopsy in two weeks if the lesion were still there.  My questions are this, what in your opinion, is the likely hood that this sounds like squamous or basal cell carcinoma?  I do not see the correlation between the sudden onset and it being a stopped up oil gland.   It would seem to me as though that skin cancer could develop quickly considering my precancerous condition. Could you please explain this. Do you think the punch biopsy is the best or would it "spread the cancer"?  Instead, should a "shave" biopsy be performed? Which biopsy would the best and safest?   If it is cancer, is it a danger to wait a couple of weeks?  This is a big concern of mine and I wnat to thank you for your time.  I will be looking forward to your response.

[Alan Rockoff, MD]

Basal and squamous cell carcinomas develop very slowly--months at a minimum, years more commonly.  The recent onset is very reassuring.  Biopsies do not spread cancer.  Punch biopsies give more information, since a superficial shave might miss deeper pathology.  In your situtation, it sounds like your dermatologist is exactly right in his approach.  By the way, I advise leaving the area alone (no rubbing or close examination) since trauma might confuse the issue and force a biopsy when you could get away without one.

Overall, though, you should relax--4-month followups for your condition are more than adequate to head off any trouble.

Best.

Dr. Rockoff