Venous lakes are a benign collection of dilated vessels which look like a blue blood blister. They are compressible and typically solitary and are dark blue to violaceous in color.
They are typically found on sun exposed areas such as the ears, lips or neck area.
Although these lesions may resemble a nodular melanoma, the fact that they lighten with compression and are slow growing are important distinguishing details.
The cause of a venous lake is unknown, however, as mentioned previously, the link to sun exposure seems to be present.
The important point is to know that these are not malignant, so treatment is based on cosmetic concerns. There are several methods of treatment that can be utilized for these lesions such as:
1. Surgical excision: this can leaving scarring to the area
2. Sclerotherapy to the lesion: consists of injection of sclerosing material
3. Electrocautery: this too can leave some scarring
4. Laser treatment: typically takes one treatment, but if large, may take two treatments.
This is the treatment that I employ because it is quite simplistic to rid the patient of this type of lesion. I use a combined pulsed dye laser with sequential emission of Nd:YAG (Cynergy laser, Cynosure, Westford, MA) and will numb the area with topical application of Hurricane gel for about 5-10 minutes.
I then use my 7 mm spot size handpiece and set my PDL to 7 joules/cm2 with 10 ms pulse duration with a short delay and typically set my Nd:YAG at 30 joules/cm2 with 15 ms duration.
The lesion will turn a darker blue with a slight whitening color. I have the patient use aquaphor if the surface of the area begins to peel, for about 3 days.
I typically will see the patient back at 4-6 weeks and 95% of the lesions are resolved. Rarely do venous lakes need a second treatment, but if they do, they are performed at the 6 week follow up appointment.
Here are some examples:nc nc