Mucoscopy of a Venous Lake.

A 56-year-old woman presented with a 5-year history of a single, painless, bluish swelling (Figure 1) over the inner aspect of the upper lip that began as a pea-sized lesion and gradually increased to the present size. There was no history of trauma or spontaneous bleeding. On examination, a single, violaceous, soft, compressible, nonindurated, nonpulsatile papule was present on the inner aspect of the upper lip. On diascopy, the lesion could be emptied of most of its blood content. Mucoscopy (polarized, 10×) revealed few red and blue lacunae with whitish veil (Figure 2). A diagnosis of venous lake was made.

Figure 1

Single bluish swelling on the inner aspect of the upper lip. [Copyright: ©2019 Jha and Pathak.]

Figure 2

Mucoscopy (polarized, 10×) reveals few red and blue lacunae with whitish veil. [Copyright: ©2019 Jha and Pathak.]

Venous lakes, also known as “phlebectases” [1], are small (0.2–1 cm), generally solitary, soft, compressible, violaceous papules commonly found on sun-exposed areas, predominantly the vermilion border of the lips and ears. Lesions generally occur among the elderly [2]. Dermoscopically, venous lake can mimic cutaneous lymphangioma circumscriptum that displays 2 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. Few lacunae can contain blood, which was characteristically accumulated in the lowest part of the lacuna, resulting in half-and-half lacuna [3]. To the best of our knowledge, this is the first report on mucoscopy in venous lake.