Back issues No.1 - 2004 / Case Report  

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Necrotizing Sialometaplasia Affecting the Upper Lip: A Sheep in Wolf’s Clothing
Ta-Tung Lee , Ming-Yu Lee , Ho-Hsing Chang , J Yu-Yun Lee
Dermatol Sinica 22 : 88-92, 2004

Necrotizing sialometaplasia(NS) is a self-limited inflammatory disease mainly involving minor salivary glands. The clinical and histological resemblance to malignancy, such as squamous cell carcinoma and mucoepidermoid carcinoma, makes this entity important. Lips are rarely involved. A 39-year-old man presented with a deep-seated nodule with central ulceration of the upper lip for a three-month duration. The tumor was biopsied followed by excision after an initial report of low-grade mucoepidermoid carcinoma. Histology of the tumor revealed necrosis of salivary glands, squamous metaplasia of salivary ducts and acini with bland appearance of the squamous cells which showed occasional nuclear atypia. The preservation of an overall lobular morphology was found, a hallmark feature of NS allowing its differentiation from malignancy pathologically. The etiology of NS is widely accepted as infarction of the glands resulting from ischemia. NS generally heals spontaneously without treatment in six to ten weeks. The NS in the present case is unusual in that it affected the lip; it thus presents as a great diagnostic challenge to both dermatologists and pathologists. An awareness of NS is important so that over-diagnosis and over-treatment of the condition as malignancy can be avoided.

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