Dermoscopy of venous lake on the lips: A comparative study with labial melanotic macule

Abstract

Background: Venous lake (VL) is a common vascular tumor occurring on the lips in the elderly. VL is sometimes difficult to distinguish from melanotic lesions such as labial melanotic macule (LMM) or oral malignant melanoma. However, the dermoscopic features of VL have not been sufficiently established in the literature.

Objective: This study was aimed at investigating the dermoscopic features of VL on the lips, and to compare the dermoscopic features of VL with those of LMM.

Methods: We retrospectively investigated the dermoscopic findings of histopathologically proven cases of VL and LMM.

Results: The structureless pattern (78.6%) and globules/clods (42.9%) were the common patterns in VL cases. Purple was the most frequent color (78.6%), followed by red (42.9%) and blue (42.9%). The structureless pattern (p = 0.003) and the colors purple (p = 0.000), red (p = 0.003), and blue (p = 0.018) were significantly more common in VL than in LMM. In contrast, lines (p = 0.000) and dots (p = 0.044) as patterns, and brown (p = 0.000) and gray (p = 0.044) colors were significantly more frequent in LMM. White structures were more common in VL than in LMM (p = 0.001).

Conclusion: Structureless patterns or globules/clods with purple, red, or blue coloration can be useful findings when differentiating VLs from LMM on dermoscopy. Therefore, dermoscopic evaluation is a helpful noninvasive ancillary tool in the diagnosis of VL.

Fig 1. Clinical, dermoscopic, and histopathologic pictures of venous lake on the lips.

(a) A dark blue papule located on the upper lip. (b) Histopathologic findings showing dilated vascular spaces and thrombi located within the vascular spaces in the upper dermis. (hematoxylin and eosin, ×40). (c) Nonpolarized dermoscopic images of venous lake taken without the use of interface fluid. (d) Polarized dermoscopic images of venous lake. Polarized dermoscopy enables better observation of color and white structures than nonpolarized dermoscopy. Venous lake shows globules/clods (black arrows), a structureless pattern (yellow arrow), and white structures (white arrows).

Fig 2. Dermoscopic findings and clinical images (insets) of venous lake on the lips and labial melanotic macules.

(a) Venous lake on the lower lip showing a purple to red structureless pattern with white structures (white arrows) and linear-irregular vessels (yellow arrows). (b) Labial melanotic macule on the upper lip composed of brown parallel lines (black arrows).