Although the lip is a very sensitive area, I find that I can deliver local anesthesia in the lip with virtually no pain. The lip receives a lot of sun damage so skin cancers are commonly found on the lip, especially squamous cell cancer. Patients who chew tobacco or smoke are very prone to squamous cell cancers arising on the lip as the carcinogens in tobacco interact with UV light to promote cancer cell formation. A shave biopsy is usually sufficient to diagnose a skin cancer on the lip. Many patients present with a purple or dark lesion on the lip, which is actually a blood vessel collection called a venous lake. These may mimic melanoma clinically, so a punch biopsy may be taken. Also, rheumatologists routinely refer patients to my clinic for salivary gland biopsies to evaluate for a disease called Sjogrens disease. Sjogrens is a disease in which patients have dry mucosal membranes and can be diagnosed with a biopsy of the mucosal lip, which contains salivary glands. In Sjogrens, inflammatory cells are residing around the salivary gland resulting in their dysfunction. As it is very difficult to suture the oral mucosa, I use a small punch biopsy to remove the salivary glands and fill the defect with a material called gel foam. The gel foam “fills the hole” left by the punch biopsy and provides hemostasis to stop the bleeding. It is naturally absorbed over one week.