To evaluate the clinical outcomes of surgical and non-surgical treatments for actinic cheilitis (AC) over a four-decade period and to introduce a novel Clinical Index for the Treatment and Control of Actinic Cheilitis (CITC-AC) for improved patient stratification and management.

A retrospective cohort study analyzed 151 patients diagnosed with AC treated at a university clinic between 1980 and 2020. Sociodemographic, clinical, and histopathological data were collected. Treatments were categorized as sun protection (SP), topical corticosteroids (TC), surgical removal (SR), and vermilionectomy. Therapeutic outcomes, recurrence rates, and malignant transformation were assessed. The CITC-AC was developed to guide clinical decision-making based on stratified risk.

A total of 87% of patients achieved therapeutic resolution. Recurrence was observed in 13%, and malignant transformation occurred in 7% of cases. Surgical treatments, particularly vermilionectomy, demonstrated superior outcomes with no recurrence or malignancy. Non-surgical treatments, including the novel use of Omcion-A Orabase, achieved favorable outcomes but exhibited higher recurrence rates. The CITC-AC provided a structured framework for stratifying patients by severity and risk, aiding in the selection of appropriate interventions and follow-up schedules.

This study highlights the importance of individualized treatment strategies and consistent follow-up in AC management. While surgical interventions remain the gold standard for advanced cases, non-surgical treatments are effective for early-stage lesions. The CITC-AC offers a practical tool for optimizing patient care and reducing progression to squamous cell carcinoma (SCC). Prospective studies are needed to validate its applicability across diverse clinical settings.