Lumps in lips: How to diagnose medical related causes
Dr Tim Pearce previously talked about diagnosing lumps in lips after filler treatment
and how you must build a complete story – the patient background, the original treatment, the presenting symptoms of a complication, and the visual and physical examination of the lip – so you have a detailed narrative upon which to make your diagnosis.
There are three broad categories of lumps in lips following dermal filler treatment:
- Procedure related causes – lumps caused by the treatment itself, the delivery method and process of placing the dermal filler into the lip which causes trauma, or may introduce infection,
- Product or substance related causes – foreign bodies as well as the filler product can play a role in lump formation,
- Medical causes – these are not related to the treatment or the product, but lumps caused by an underlying medical condition.
In this blog, the third in a small series of three, Dr Tim Pearce will share some expert tips on non-procedure, not product but medical related lumps in lips – those caused by an underlying medical condition, medication, or allergies, and unrelated to either the treatment or product used.
What are medical related lumps in lips?
Medical related lumps are also referred to as non-procedure or non-product related which are part of normal, human physiology or pathological in nature, and an important consideration when diagnosing lumps in lips.
Non-procedure or non-product related lumps can be divided into six types – Fordyce spots, mucoceles, aphthous ulcers, callous (frictional keratosis), scars, and cancers.
How to diagnose non-procedure or non-product related lumps in lips
Referring to the ‘story’ that aesthetic clinicians should be aiming to build when assessing and diagnosing lumps in lips – patient, procedure, symptoms, and signs – Dr Tim explains some examples of the primary stories that you may encounter when considering and diagnosing medical related complications that cause lumps in lips after filler treatment.
Diagnosing Fordyce spots
A common complaint from patients following lip filler treatment is the appearance of small white dots on the lips – Fordyce spots. Approximately 80-90% of people have Fordyce spots, which are sebaceous glands, on one or more of their mucous membranes, particularly the lips. These white dots can become more apparent as post-procedural lip redness highlights a contrast with the paler-looking spots.
Patients, who are now scrutinising their lips more closely in the mirror, may notice these spots for the first time (even though they have always been present) after they have been revealed by filler treatment. Fordyce spots are normal, non-pathological and are not caused by the lip procedure, but anxious patients may report a concern for this symptom and be worried. On examination, signs that confirm Fordyce spots are small white dots around the oral mucosa and inside the mouth. Reassurance is all that is required for the patient.
Mucoceles are caused by minor trauma to a salivary duct which decreases the flow of saliva out of the tissue creating a build-up or bubble of saliva in a lump. These are a common concern for patients but are usually painless and will self-resolve in 3-6 weeks.
The cause is usually from the top and bottom teeth coming together and biting around the tissue and is unrelated to potential trauma from injection during a filler procedure as these are not performed on the inside of the mouth, although in very rare cases a mucocele could be caused by accidental penetration, but the management would be the same. Patients will describe symptoms of a small, firm, painless but bothersome lump on the inside of the mouth near where the incisors meet. Examination will show signs of a 2-10mm isolated lump in the top layer of the skin. If it is deeper and mobile, on palpation, this could indicate a lump of filler (which can be massaged), or a reactionary or delayed onset nodule and not a mucocele.
Diagnosing aphthous ulcers
Aphthous ulcers are common after filler procedures, but most patients will self-diagnose and not get in touch, allowing them to heal. However, more anxious patients may be concerned that it is a complication and return to your clinic. Aphthous ulcers tend to be associated with patients who experience stress and have a history of aphthous ulcers; they can also be associated with serious systemic diseases including ulcerative colitis, so a patient history is paramount. It is very unlikely that the procedure is directly related to this outcome unless there was trauma to the inside of the mouth. Symptoms and signs will show an ulceration that is very painful to the touch, usually on the inside of the lip, which on examination is surrounded by clear inflammation, but which fades and recovers quickly. Note time frames of the ulcer and resolution as any non-healing ulcer could be a sign of oral cancer and should be referred onwards to their GP.
Diagnosing oral cancers
If the patient is an older person, there is a heightened risk for cancerous lesions and oral cancers. Risk factors for oral cancer include high alcohol intake (particularly spirits) and smoking.
Many patients start to notice other things about their face after they have had an aesthetic procedure, which may include a lump that they did not spot until after their treatment. The two things will be unrelated, and the lump will persistent over time.
Oral cancers can be flat and white, discoloured lesions on the inside of the surface of the skin, or irregular, nodular lumps that often occur on the inside of the cheek or lower lip.
Signs of a persistent, growing lump – an ulcer that does not heal for weeks, or a lump in a high-risk patient – should be enough cause for concern for referral to their GP; any delay could impact on the diagnosis of a life-threatening condition.
Learn more about how to diagnose, manage and treat lumps in lips.
Lip Filler Treatment & Complications
With all the conflicting advice out there about lip filler treatments – vertical or horizontal? needle or cannula? – it can be difficult to know how to inject to create the lips your patient desires.
If you are suffering from technique overwhelm, worrying about causing a vascular occlusion (VO), or panicking about injecting thin lips, then Dr Tim Pearce’s brand-new ultimate lip course is going to teach you the different techniques, anatomy, and skills you need to create medically beautiful lips.
Dr Tim Pearce eLearning
Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.
Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.
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