Introduction
Venous lakes are benign dilated venules that typically present as soft, compressible, dark-blue papules on sun-exposed mucocutaneous surfaces such as the lower lip. Though usually asymptomatic, they are cosmetically noticeable and may mimic other pigmented or vascular lesions.
Case summary
This report documents a solitary, well-circumscribed dark-blue papule on the lower lip that was soft and compressible on palpation. There was gradual onset with no history of trauma. Clinical assessment favored a venous lake; no alarming features were present.
Key clinical features
- Small, dome-shaped, dark-blue papule located on vermilion border
- Compressible with partial blanching on pressure
- Asymptomatic, primarily a cosmetic concern
Differential diagnosis
Important differentials include pigmented melanoma (rare on the lip), pyogenic granuloma, venous malformation, and mucoceles. Dermoscopy, clinical history and, when needed, excision with histopathology help exclude malignant or other vascular lesions.
Treatment options
Choice of treatment depends on lesion size, location and patient preference. Options include:
- Electrocautery / diathermy
- Laser ablation (pulsed-dye or Nd:YAG)
- Simple excision with primary closure (for diagnostic confirmation or larger lesions)
- Cryotherapy (may risk pigmentary change)
Practical takeaway
Most venous lakes can be confidently diagnosed clinically. Less invasive treatments often give excellent cosmetic outcomes. Reserve excision when histology is required or when less invasive modalities are unsuitable.