Caliber persistent labial artery (CPLA): A rarely recognized cause of a lower lip swelling. Report of 5 cases and review of the literature

Abstract Caliber persistent labial artery (CPLA) is a vascular anomaly of the labial artery which penetrates into submucosa of the lip without reduction in diameter. It commonly presents as a bluish or normal color elevated soft tissue mass and usually pulsates on manual palpation. Five patients aged between 28 and 88 years old presenting with discrete lesions of the lower lip are presented. All cases were treated with excision biopsy. Persistence of the lesion following excision was seen in only 1 case and in another single case a patient complained of persistent paresthesia at the surgical site on review at 7 months post-biopsy. All cases were diagnosed clinically as either mucocele or squamous cell carcinoma (if associated with ulceration). Excisional biopsies showed a prominent muscular vessel in the stroma which was associated with ulceration in two cases. CPLA carries the risk of profuse bleeding if the artery is transectioned during biopsy. In the cases presented here, hemostasis was achieved by either application of surgical diathermy or ligation with deep sutures at the wound area. Correct clinical recognition of CPLA may have eliminated the need for biopsy in some cases which may have spared the risk of hemorrhage from the procedure. CPLA should be considered in the differential diagnosis of any raised soft tissue lesion affecting the lip. Careful inspection with palpation for pulse during clinical examination should permit clinical diagnosis and may prevent unnecessary surgical treatment or prepare the operator for possibility of hemorrhage during surgery. Pathologists can be alerted to the possibility of CPLAwhere an isolated muscular vessel is encountered in a lip biopsy.