Cheilitis Glandularis

Cheilitis glandularis is a crazy, rare disease characterized by an enlarged lower lip which is everted, and usually has pronounced openings of the minor salivary glands.  The lip is usually glazed with a thick mucoid discharge, and upon squeezing of the lower lip, prominent mucoid discharge can be seen from the patulous gland openings.  If you touch your (gloved) finger to the lip, you will get the "string sign" of sticky mucus, as is shown in the picture.  There is a suppurative variety which involves infection of the minor salivary glands, but it is uncommon.  The only realistic ddx for this condition is Miescher-Melkersson-Rosenthal Disease, which involves a granulomatous swelling of the lips, plicated tongue and sometimes facial palsy but does not have the thick mucus discharge.  You will find cheilitis glandularis in both genders and any age group, but middle aged men are most likely to have it.  It can be associated with SCC of the lower lip.

This was a very, very difficult case, but a classic one nevertheless.