Chapter 38: Venous Lakes

INTRODUCTION

Venous lakes are benign vascular lesions that result from dilated venules. They commonly affect the lips, face, and ears.

EPIDEMIOLOGY

Incidence: common

Age: most commonly observed in the elderly

Precipitating factors: may be related to sun exposure

PHYSICAL EXAMINATION

Venous lake presents as dark blue to violaceous, elevated, soft, and easily compressible papule or nodule.

DIFFERENTIAL DIAGNOSES

Pyogenic granuloma, melanoma, labial melanotic macule, atypical nevus, hemangioma.

DERMATOPATHOLOGY

Dilated thin-walled venules in the superficial dermis. Thrombosis may be observed.

EPILUMINESCENCE MICROSCOPY

Epiluminescence microscopy (ELM) reveals erythematous globules with no pigmentary network. It is helpful in differentiating this vascular lesion from a melanocytic lesion.

COURSE

They usually persist for years and can bleed after trauma.

MANAGEMENT

Venous lakes are frequently treated for cosmetic purposes. Multiple treatment options exist.

• Light treatment

  • – Lasers (Figs. 38.1–38.3)

• • • Pulsed dye laser (585–595 nm, 0.45–1.5 ms, 5–10 mm spot, 7–10 J/cm², DCD 30–40/20, with and without diascopy). Pulsed dye laser provides inconsistent benefit for venous lakes.

    • Diode laser (800–810 nm, 30 ms, 30–50 J/cm²) can also be a very effective treatment. It is helpful to allow 3 seconds of compression of the lesion with the chill tip prior to the laser pulse. A physical “kickback” is often felt by the laser surgeon at the time of the pulsation. The clinical endpoint is immediate purpura.

    • Long-pulsed Nd:YAG laser and intense pulsed light (IPL) have also been reported to be effective.

• Sclerotherapy: In one study, intralesional injections with 1% polidocanol have been shown to be effective in clearing two venous lakes after two sessions of sclerotherapy. A scar was noted to occur in one patient.

• Electrosurgery, surgical excision, cryotherapy are ...