Are You Confident of the Diagnosis?

What you should be alert for in the history

Venous lakes occur most often in the elderly and are usually asymptomatic.

Characteristic findings on physical examination

Characteristically, venous lakes are small, dark-blue, soft lesions with slight elevations, which are mostly localized to the lips, ears and face (Figure 1). The lesions blanch with prolonged, persistent pressure

Figure 1.

Small venous lake on the lower lip. Presents as a small purple macule. (Courtesy of Bryan Anderson, MD)

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Expected results of diagnostic studies

Histopathology results show dilated, dermal venules or several communicating dilated venules.

Diagnosis confirmation

Nodular melanoma can be distinguished by the presence of induration, growth over time, and lack of lightening with pressure. Dermoscopy may be very helpful in the differentiation of these lesions.

Who is at Risk for Developing this Disease?

The elderly are the most often affected by the condition.

What is the Cause of the Disease?

The etiology is unknown. Given the facial distribution, there is a possible role for sun exposure.


Dilated, dermal venules with blood pooling.

Systemic Implications and Complications

Differential diagnosis includes nodular melanoma; careful monitoring for growth or changes is recommended.

Treatment Options

Treatment is usually unnecessary. Electrosurgery, cryosurgery, sclerotherapy, pulsed-dye laser or infrared coagulation can bring about cosmetic improvements.

Optimal Therapeutic Approach for this Disease

Treatment is usually unnecessary and reassurance should be given to the patient and their family. Surgical and laser-based therapies are effective if treatment is desired.

Patient Management

Watchful waiting is the first line of patient management and reassurance of the patient is key. Surgical and laser-based therapies can be offered if treatment is desired.

Unusual Clinical Scenarios to Consider in Patient Management

Any increase in growth or the presence of symptoms should prompt concern for a neoplastic proliferation and biopsy for histopathologic examination.

What is the Evidence?

Baker, C, Kelly, R, Bolognia, JL, Jorizzo, JL, Rapini, RP. “Other Vascular Disorders”. In Dermatology. 2008. pp. 1615-1625. (An excellent textbook review of venous lakes and other vascular lesions.)