External factors and internal systemic factors expose the lips since they belong to the oral mucosa and thus create susceptibility to multiple dermatological and mucosal conditions. Proper early identification of lip conditions remains vital because it enables both efficient treatment evaluation as well as detecting the initial stages of cancerous tissue development. The current diagnostic approaches depend on both medical evaluations and tissue examination although these procedures are both invasive to patients and cannot deliver rapid diagnostic outcomes.

The non-invasive diagnostic method known as dermatoscopy now operates as mucoscopy to examine mucosal surfaces after adapting its use from skin lesion evaluations. The technique enables direct visualization of hidden subsurface features and blood vessels which normal eyes cannot see because it leads to faster diagnoses of mucosal lesions (1). The use of mucoscopy proves effective for discerning minimal pigmentary along with vascular changes in conditions like lichen planus vitiligo and mucoceles (2,3).

Routine clinical practice incorporates mucoscopy with limited effectiveness especially for treating lip-related disorders. The lack of standardization together with poor awareness and inadequate literature on precise mucoscopic features of different lip pathologies hinders their wider application. Dermoscopic examinations of lip lesions in different population groups need more extensive investigation because limited systematic research exists.

The advancement of dermoscopic technology through high-resolution polarized and ultraviolet mode designs now enables scientists to study mucosal surfaces more clearly. Mucoscopy helps health professionals observe specific attributes like pigment networks and vascular structures and scales and structureless zones that clinicians might otherwise miss while doing standard clinical assessments. Mucoscopic evaluation delivers valuable diagnostic clues to healthcare providers for distinguishing smoker’s melanosis along with actinic cheilitis and discoid lupus erythematosus from potentially dangerous or infectious lesions (4,5). The benefit of mucoscopy includes continuous observation of lesion development and treatment effects which makes it an essential tool for follow-up assessments.

Widespread investigation of mucoscopy diagnostic capability in oral conditions exists but limited confirmation about its applicability to lip conditions occurs (6,7). Several studies demonstrate that oral lichen planus displays mucoscopic features that include three distinct patterns: white reticular lines (Wickham striae) along with reddish structureless areas and changes in blood vessel appearance - all of these findings can also be seen in lip presentations (8). Standardized dermoscopic terminology together with insufficient population-based studies makes it challenging for doctors to determine precise diagnosis criteria between different lip conditions. Widespread adoption of this method remains restricted for both dermatology and dental practice.

The growth of oral and lip disorders caused by smoking and systemic immunologic conditions and UV exposure requires simple non-invasive cost-effective diagnostic methods. The diagnostic deficiencies in detecting premalignant transformations are solved successfully through mucoscopy which assists medical professionals in spotting early potential cancer markers specifically for at-risk populations. Health facilities that lack biopsy and histopathology capabilities can implement mucoscopy as an important diagnostic instrument for their patients.

The current research initiative works to link the knowledge gap through its assessment of mucoscopic patterns in various lip conditions found in tertiary care facilities. The analysis of specific features for different conditions within this study will enhance both accuracy of medical diagnoses and permit earlier treatments while reducing the requirement for invasive testing.

A one-year duration research involved patient observations at a tertiary care teaching hospital during the period of May 2023 to May 2024 through this cross-sectional observational study. The researchers examined mucoscopic patterns across different lip disorders that appeared in patients during clinical examination.

Study Population

The research included 164 patients who were older than 18 years and had detectable lip lesions. The study researchers selected participants only when they obtained documented consent from the patients. Before commencing research the study obtained ethical approval from the institutional ethics committee.

Inclusion Criteria

• Patients aged 18 years and above
• Patients with clinical evidence of lip disorders

The subjects who granted written consent to join the study

Exclusion Criteria

• Patients below 18 years of age

The study excluded patients who refused to grant their consent about study participation.

The examination method had restrictions designed for patients who showed bleeding at their mucoosal sites during the evaluation process.

Clinical and Mucoscopic Examination

The patients received detailed historical evaluation then underwent clinical assessments under appropriate light conditions. A DermLite DL5 dermatoscope enabled mucoscopic evaluation by using 10–20x magnification with the examination conducted in polarized and non-polarized and ultraviolet (UV) modes according to the lesion features. Fitzpatrick skin typing was recorded for all patients to assess associations with pigmented lip lesions, particularly smoker’s melanosis and post-inflammatory hyperpigmentation

The diagnostic instrument used an interface fluid of isopropyl alcohol whenever better clarity became necessary. Hygiene protection along with contamination prevention required the use of an ice cap to isolate the lip surface from the dermatoscope.

The evaluation of lesions included assessment for pigmentation patterns along with vascular architecture and structureless areas besides scaling and other diagnostic characteristics. The research team documented their findings by combining clinical photographs with dermoscopic images for analysis to establish correlations between them.

Data Collection and Analysis

Therapeutic findings were recorded through official documentation that included classification of mucoscopic patterns according to their observed morphological features. The analysis of collected data found the patterns' frequencies in conditions affecting the lip including vitiligo, smoker’s melanosis, mucoceles and other diseases.

A total of 164 patients were included in this study, with various lip disorders diagnosed based on clinical and mucoscopic features. The most common condition observed was lip vitiligo, followed by smoker’s melanosis and mucocele.

Distribution of Diagnosed Lip Disorders

Out of 164 participants, Lip vitiligo (most frequently involving the lower lip vermilion) and smoker’s melanosis (predominantly affecting the inner mucosal aspect of the lower lip) were diagnosed in 45 patients (27.4%), followed by smoker’s lips in 25 patients (15.2%), and mucocele in 4 patients (2.4%). Other findings included pigmentary and inflammatory conditions such as cheilitis, lichen planus, and post-inflammatory hyperpigmentation.

Table 1 presents the frequency distribution of major lip disorders.

Table 1: Distribution of Lip Disorders among Study Participants (N = 164)

Among 45 cases of lip vitiligo, 35 (78%) involved the lower lip vermilion, while 10 (22%) showed lesions on the upper lip vermilion or lip commissures. Of the 25 cases, 19 (76%) involved the inner mucosal aspect of the lower lip, while 6 (24%) also showed pigmentation on the upper lip mucosa or at the labial commissures. Mucoceles were observed in 4 patients; 3 (75%) on the lower labial mucosa and 1 (25%) on the inner aspect of the upper lip. Lichen planus and DLE involved the lip commissures and central lower lip. Cheilitis primarily involved the vermilion border, while aphthous ulcers were mostly found on the labial mucosa. Lichen planus involved lip commissures in 4/6 cases (67%), and central lower lip in 2/6 cases (33%). DLE: Primarily affected the central lower lip (2 cases), with 1 case on the upper lip. Cheilitis: Mainly observed at the vermilion border (10/12, 83%), remaining on inner labial surface. Aphthous ulcers: Distributed across the lower labial mucosa in 5 cases and upper in 2 cases.

Common Mucoscopic Patterns Observed

Distinct mucoscopic features were noted for different lip disorders. Vitiligo cases frequently showed perifollicular hypopigmentation, peripheral pigment fading, and structureless white areas. Smoker’s lips showed a moth-eaten border, black-gray homogenous areas, and dot vessels. Mucoceles consistently exhibited reddish-white structureless zones with bleeding spots and a dense vascular network with linear and branched vessels.

Table 2 summarizes key mucoscopic patterns associated with specific lip conditions.

Table 2: Mucoscopic Features Noted in Various Lip Disorders

(FIGURE 1 ,2,3,4)

Age and Gender Distribution

Patients ranged in age from 18 to 65 years, with a mean age of 36.7 ± 11.2 years. A male predominance was observed, with 97 males (59.1%) and 67 females (40.9%).

Table 3 provides the age and gender breakdown of the study population.

Table 3: Demographic Characteristics of Study Participants

Fitzpatrick skin types ranged from Type III to V among participants. Smoker’s melanosis and post-inflammatory hyperpigmentation were more common among individuals with Fitzpatrick Type IV and V skin. Additionally, a positive correlation was observed between the duration of smoking (≥10 years) and severity of melanotic pigmentation on the lips. A statistically significant association was found between. Fitzpatrick Skin Type IV/V and smoker’s melanosis (p < 0.05), Smoking duration (>10 years) and pigmentation severity (p < 0.01), Daily cigarette consumption (≥10/day) and intensity of pigmentation (p = 0.03). Among 164 participants, those with Fitzpatrick Skin Types IV and V exhibited a higher prevalence of smoker’s melanosis and post-inflammatory hyperpigmentation (p < 0.05). This indicates a skin-type–dependent predisposition to lip pigmentation. A positive correlation was established between smoking history and lip pigmentation intensity: Mean duration of smoking among affected individuals was 11.2 years. Patients smoking ≥10 cigarettes/day showed greater pigmentation severity. Both variables showed statistical significance (p < 0.01).

Table 4: Gender-wise Distribution of Major Lip Disorders (N = 164)

A statistically significant gender-based difference was observed in the distribution of lip disorders (p = 0.0472), indicating a potential sex-linked variation in prevalence of specific conditions, especially smoker’s melanosis, which was more common in males.

Table 5: Site-wise Distribution of Lip Disorders

Site-specific predilection was found to be statistically significant (p = 0.0002), confirming that different lip disorders tend to affect particular anatomical regions (e.g., vitiligo on vermilion, smoker’s melanosis on inner mucosa, mucocele on labial mucosa).

(Figure 1-5)

The research investigated mucoscopic inspectable characteristics of different lip conditions found in a tertiary care hospital. New technology mucoscopy serves as an effective diagnostic helper to reveal faint morphological patterns in both pigmented and inflammatory lip lesions.

Lip vitiligo appeared as the dominant diagnosis in our study population which made up 27.4% of total cases. The mucoscopic observations of perifollicular hypopigmentation together with peripheral pigment fading align with the descriptions made by Jakhar et al. for mucosal vitiligo (1). The diagnostic findings assist medical professionals distinguish lip depigmentation in vitiligo from the depigmentation causes of lichen sclerosus and post-inflammatory hypopigmentation (2,3).

Users should consider blackish-gray homogenous pigmentation along with a moth-eaten border and dot vessels as characteristic signs of Smoker's melanosis. The research by Kara et al. supports this observation since their study demonstrated that long-term tobacco usage changes melanocyte activity resulting in these particular dermoscopic features (4). These visual characteristics enable medical professionals to distinguish smoker's melanosis from other types of brown-colored lesions (5,6). The condition was notably more prevalent among individuals with Fitzpatrick Skin Type IV and V. There was a clear positive correlation between the degree of pigmentation and smoking history—both in terms of duration (mean duration: 11.2 years) and number of cigarettes per day (≥10/day), supporting earlier findings on cumulative melanogenic stimulation in smokers.

Among the examined cases Mucocele appeared only 2.4% of the time while displaying distinctive mucoscopic features which included red and white structureless tissue and bleeding points in combination with prominent linear and branched vessels. Research by Kaur et al. and Jakhar et al. supports our findings because they confirmed mucoceles have a vascular character and mucoscopy helps make reliable diagnoses (7,8). Mucoscopy patterns enable medical practitioners to differentiate mucoceles from both vascular tumors and minor salivary gland neoplasms (9).

The mucoscopic appearances of lichen planus alongside DLE included the diagnostic Wickham striae and shiny surface together with branching vessels exactly as reported in previous literature (10,11). The dermoscopic indicators help identify lichen planus separately from leukoplakia and early squamous cell carcinoma (12).

Mucoscopy of dry cheilitis showed exaggerated radial wrinkles together with hemorrhagic suffusions in the area of analysis. The observed patterns during mucoscopy studies match xerotic and actinic cheilitis diagnoses which substantiates the value of mucoscopy for inflammatory and environmental lip problems (13).

Through mucoscopy clinicians can alterably conduct both disease diagnosis at an early stage and observe the patient's health status together with assessing therapy results while also refraining from superfluous biopsies (14). Clinical surveillance with mucoscopy helps physicians detect early signs of malignant transformation specifically in patients who have leukoplakia and actinic cheilitis patients (15).

Mucoscopy has numerous benefits for diagnosing lip disorders but its use remains scarce for this purpose. Medical practitioners lack sufficient awareness about mucosyoscopic tools while national diagnostic criteria remain nonexistent and training programs are scarce. These factors create significant obstacles for its clinical deployment. Mucoscopy's implementation into dermatological and dental practice streams will lead to improved diagnostic precision together with lowered patient distress and better therapeutic results.

Mucoscopy serves as an important non-invasive evaluation method which allows clinicians to identify hidden aspects of lip diseases through visualization of delicate pigmentations and blood vessels. Research demonstrates the essential contribution of mucoscopy to detecting and distinguishing between vitiligo along with smoker's melanosis and mucocele during early diagnosis. Mucus examination should become a standard practice in dental and dermatology examinations because it enables precise diagnostic results while diminishing the requirement of biopsies and leading to better patient health outcomes.

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