Venous Lake of the Lip

A 46-year-old Caucasian male presented with an asymptomatic, solitary, dark blue, soft papule on his upper lip. The lesion was first noted 2 years ago and was slowly growing. He enjoyed outdoor activities. Physical examination revealed a soft, compressible, well-circumscribed, dark-blue papule on the upper lip. The lesion measured 5 mm in diameter.  (Figure) The color of the lesion got slightly lighter on diascopy. Dermoscopic examination revealed a homogeneous blue-black color with no pigment network structures. 

Based on clinical and dermoscopic findings, a diagnosis of venous lake of the lip was made. The patient was reassured as to the benign nature of the lesion and no treatment was required.  

Discussion. Venous lake is a common acquired form of vascular ectasia formed from dilated venules in the upper dermis. In a study of 1408 patients (mean age of 52.6 years) seen in a dermatology clinic, 52 (3.7%) patients had venous lakes of the lips.¹ The condition is more common in fair-skinned elderly men.

Aging and chronic exposure of sunlight with resultant damage to the walls of the superficial veins may be responsible. Histologically, a single layer of flattened endothelial cells and a thick wall of fibrous tissue line the lesion.²

Clinically, a venous lake presents as an asymptomatic, soft, compressible, well-circumscribed, dark-blue or violaceous, papule/nodule with a smooth surface.¹ The size of the lesion is usually 2 mm to 10 mm. The lesion is most commonly found on the lips, most commonly lower lip.² The helix of the ears, face, and neck are other commonly affected areas.²

The diagnosis is mainly a clinical one and can be aided by dermoscopy. Differential diagnoses include melanoma, pigmented basal cell carcinoma, blue nevus, lentigo, pyogenic granuloma, and cherry hemangioma.

Venous lake of the lip can be aesthetically bothersome. Bleeding may occur if the lesion is traumatized.² The condition is benign, although it tends to persist throughout life. Treatment is primarily for cosmesis. Treatment options include cryosurgery, electrodessication, laser ablation, excision, intense pulsed light or a vascular laser, and least commonly sclerosing agents.² 

References:

1. Menni S, Marconi M, Boccardi D, Betti R. Venous lakes of the lips: prevalence and associated factors. Acta Derm Venereol. 2014;94(1):74-75.

2. Azevedo LH, Galletta VC, Eduardo Cde, Migilari DA. Venous lake of the lips treated using photocoagulation with high-intensity diode laser. Photomed Laser Surg. 2010;28(2):263-265.