Mucoscopy in lingual varicosities.

Case Report

A 62-year-old woman presented with complaints of asymptomatic tortuous purplish to black swellings on the undersurface of the tongue for 8 months (Figure 1). She first noticed a few red to purple small outpouching of the veins on the undersurface of tongue. The lesion has increased progressively in due course of time. On mucosal examination, dilated tortuous vessels were seen along the lateral portions of undersurface of the tongue. Examination of the skin, hair and other mucosal surfaces were normal. There was no history of bleeding from the site and there was no evidence of any associated systemic disease. Dermoscopy [polarized, 10X] showed red lacuna with whitish veil at a few places, and based on location, age, clinical and dermoscopic appearance, it was diagnosed as lingual varicosities.

Figure 1

Tortuous purplish to black swellings on the undersurface of the tongue. [Copyright: ©2018 Jha et al.]

Discussion

Caviar tongue, also known as lingual varicosities and sublingual varices, is considered as a physiological change associated with advancing age, usually developing due to senile elastolytic degeneration of sublingual veins [1,2]. It is mostly seen at the undersurface of the tongue along the sublingual glands where the mucosal surface is thin and translucent which permits visualisation of submucosal vascular structures [1].

On dermoscopy, dark-blue lacunae (Figure 2) suggest vessel thrombosis and red lacunae suggest absence of it [2]. Dermoscopically, hemangiomas also show red-bluish lacunae but lack the sharp dermarcation seen in angiokeratoma of Fordyce [3]. Pyogenic granuloma reveals whitish veils, but lack the red-blue lacunae [4]. Cutaneous lymphangioma circumscriptum displays two distinct patterns: yellow lacunae surrounded by pale septa without inclusion of blood and yellow to pink lacunae alternating with dark-red or bluish lacunae, due to the inclusion of blood. A few lacunae contained blood, which was characteristically accumulated in the lowest part of the lacuna, resulting in an appearance similar to the so-called “hypopyon” of the eye, a new “dermatologic” metaphoric term has been used to describe this peculiar feature as half-and-half lacuna [5]. The patient was counseled about the benign nature of the diseaseand that is common in the elderly; no treatment was given.

Figure 2

Dermoscopy [polarized, 10X] showed red lacuna with whitish veil at few places. [Copyright: ©2018 Jha et al.]

Sclerotherapy, surgery, or photocoagulation with high intensity diode laser or NdYag laser has been tried in few lesions on unusual locations, such as the lips or buccal mucosa.

In conclusion, dermoscopy can be an auxiliary tool in the diagnosis of lingual varicosities. To the best of our knowledge, this is the first report on dermoscopy of caviar tongue.