Practice Essentials
Venous lakes manifest as dark blue-to-violaceous compressible papules caused by dilation of venules. They were first described in 1956 by Bean and Walsh, who noted their compressibility and predilection for sun-exposed skin, especially the ears of elderly patients. [1] Although benign, venous lakes are important because of their mimicry of malignant lesions, such as melanoma and pigmented basal cell carcinoma.
A venous lake is an acquired form of vascular ectasia (vascular dilatation). A capillary aneurysm is considered a precursor or variant of a venous lake.
Two main theories regarding the development of venous lakes have been proposed. The first involves injury to the vascular adventitia and the dermal elastic tissue due to long-term solar damage permitting dilatation of superficial venous structures. The second theory involves the involvement of vascular thrombosis in the development of venous lakes. Thrombosis is commonly present in lesions of this type; however, whether the thromboses is a primary or a secondary event in the development of these lesions is unclear.
Blood laboratory studies are not usually indicated in the evaluation of venous lakes and other lesions of this type. Pathologic examination can prove useful in confirmation of a clinical diagnosis of venous lakes. Punch or shave biopsy can be used to obtain a specimen from the venous lake for pathologic confirmation of diagnosis.
Treatment usually is performed for cosmetic reasons or to alleviate recurrent bleeding. See Surgical Care.
Consultation with a dermatologist is usually appropriate for confirmation of the clinical diagnosis of venous lakes.
Epidemiology
The worldwide incidence of venous lakes is unknown, but they are believed to be common. No racial predilection has been documented for venous lakes.
Bean and Walsh reported that 95% of venous lakes were observed in males. [1] Another review of venous lakes confirmed the same sex distribution. The disproportionate male distribution may be related to occupational sun exposure, hair length, and hairstyles. Women comprised the majority of treated patients in a large study of laser therapy for venous lakes; however, this may be related to increased concern among women regarding cosmetic appearance rather than with true incidence.
Venous lakes have been reported only in adults and usually occur in patients older than 50 years. The average age of presentation for venous lakes has been reported to be 65 years.
Prognosis
The prognosis for venous lakes is excellent. Although venous lakes do not resolve on their own, patients can be reassured that venous lakes do not evolve into a more serious pathology, such as a skin cancer. Mortality from venous lakes has not been reported. Venous lakes are usually asymptomatic, although pain, tenderness, and excessive bleeding may occur if a lesion is traumatized. Venous lakes are considered biologically harmless.
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Venous lake on the helix of the ear.
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Venous lake on the lower lip.
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Venous lake of the lip. Note the apparent actinic damage of the surrounding skin. Courtesy of Albert C. Yan, MD.
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Venous lake becomes inconspicuous during diascopy with a glass slide.
