eMedicine Specialties > Dermatology > Diseases of the Vessels

Venous Lakes

Author: Jining Wang, MD, Department of Dermatology, Dean Health System
Coauthor(s): Kim Wang, MD, Staff Physician, Department of Pathology, Northwestern University Medical School
Contributor Information and Disclosures

Updated: Feb 28, 2007

Introduction

Background

Venous lakes manifest as dark blue-to-violaceous compressible papules caused by dilation of venules. They were first described in 1956 by Bean and Walsh, who noted how they can be easily compressed and their tendency to occur on sun-exposed skin, especially the ears of elderly patients. Although venous lakes may be considered clinically insignificant from a biological standpoint, they are important because of their mimicry of more ominous lesions, such as melanoma and pigmented basal cell carcinoma.

Pathophysiology

Vascular anomalies are classified into various groups, including malformations, hamartomas, vascular ectasias, vascular hyperplasias, and benign and malignant neoplasms. Venous lakes represent a form of vascular ectasia (vascular dilatation). This group of diseases also includes spider angiomas and telangiectases. A capillary aneurysm is considered a precursor or variant of a venous lake.

The development of venous lakes is believed to be exacerbated by solar exposure and damage. One theory is that chronic solar damage injures the vascular adventitia and the dermal elastic tissue, permitting dilatation of superficial venous structures.

Vascular thrombosis also may play a role in the development of these lesions because thrombosis is commonly present in lesions of this type. Whether thrombosis is a primary or a secondary event in the development of these lesions is unclear.

Frequency

United States

The incidence of disease in the United States is not believed to differ from the incidence worldwide.

International

Although the exact incidence is unknown, venous lakes are common.

Mortality/Morbidity

Mortality from venous lakes has not been reported. There is very little associated morbidity, and lesions typically are considered biologically harmless. Venous lakes are usually asymptomatic, although pain, tenderness, and excessive bleeding can occur once a lesion has been traumatized.

Race

No racial predilection has been documented.

Sex

Bean and Walsh reported that 95% of venous lakes were observed in males. Another review of venous lakes confirmed the same gender distribution. It has been suggested that the disproportionately male distribution may be related to occupational sun exposure, hair length, and hairstyles. Women comprised the majority of treated patients in a large study of laser therapy for venous lakes; however, this may be related to increased concern among women regarding cosmetic appearance rather than with true incidence (a selection bias).

Age

Venous lakes have been reported only in adults and usually occur in patients older than 50 years. The average age of presentation has been reported to be 65 years.

Clinical

History

Venous lakes occur most commonly in adults older than 50 years with a history of chronic sun exposure. The typical presentation is as an asymptomatic lesion.

Physical

Physical examination usually reveals a soft, compressible, violaceous papule, up to 1 cm in greatest diameter. The lesions usually are well demarcated with a smooth surface, and compression often causes a transient depression. Lesions typically are distributed on the sun-exposed surfaces of the face and neck, especially on the helix and antihelix of the ear and the posterior aspect of the pinna (see Image 2). Another common site of involvement is the vermilion border of the lower lip (see Image 3). Sometimes, several lesions are found on the same person, and the surrounding skin reveals actinic damage (see Image 1).

Causes

Solar elastosis is believed to contribute to the development of venous lakes via alteration of vascular and dermal elastic fibers.

More on Venous Lakes

Overview: Venous Lakes
Differential Diagnoses & Workup: Venous Lakes
Treatment & Medication: Venous Lakes
Follow-up: Venous Lakes
Multimedia: Venous Lakes
References
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References

  1. Ah-Weng A, Natarajan S, Velangi S, Langtry JA. Venous lakes of the vermillion lip treated by infrared coagulation. Br J Oral Maxillofac Surg. Jun 2004;42(3):251-3. [Medline].

  2. Alcalay J, Sandbank M. The ultrastructure of cutaneous venous lakes. Int J Dermatol. Dec 1987;26(10):645-6. [Medline].

  3. Bean WB, Walsh JR. Venous lakes. AMA Arch Derm. Nov 1956;74(5):459-63. [Medline].

  4. Bekhor PS. Long-pulsed Nd:YAG laser treatment of venous lakes: report of a series of 34 cases. Dermatol Surg. Sep 2006;32(9):1151-4. [Medline].

  5. Boffa MJ. Pulsed dye laser treatment of thick/raised vascular lesions using compression with clear plastic. J Am Acad Dermatol. Nov 2003;49(5):879-81. [Medline].

  6. Colver GB, Hunter JA. Venous lakes: treatment by infrared coagulation. Br J Plast Surg. Sep 1987;40(5):451-3. [Medline].

  7. Goldberg LH, Altman AR. Venous lakes of the ears. Cutis. Dec 1985;36(6):472-5. [Medline].

  8. Jay H, Borek C. Treatment of a venous-lake angioma with intense pulsed light. Lancet. Jan 10 1998;351(9096):112. [Medline].

  9. Kuo HW, Yang CH. Venous lake of the lip treated with a sclerosing agent: report of two cases. Dermatol Surg. Apr 2003;29(4):425-8. [Medline].

  10. Landthaler M, Haina D, Waidelich W, Braun-Falco O. Laser therapy of venous lakes (Bean-Walsh) and telangiectasias. Plast Reconstr Surg. Jan 1984;73(1):78-83. [Medline].

  11. Neumann RA, Knobler RM. Venous lakes (Bean-Walsh) of the lips--treatment experience with the argon laser and 18 months follow-up. Clin Exp Dermatol. Mar 1990;15(2):115-8. [Medline].

  12. Polla LL, Tan OT, Garden JM, Parrish JA. Tunable pulsed dye laser for the treatment of benign cutaneous vascular ectasia. Dermatologica. 1987;174(1):11-7. [Medline].

  13. Requena L, Sangueza OP. Cutaneous vascular anomalies. Part I. Hamartomas, malformations, and dilation of preexisting vessels. J Am Acad Dermatol. Oct 1997;37(4):523-49; quiz 549-52. [Medline].

  14. Ross BS, Levine VJ, Ashinoff R. Laser treatment of acquired vascular lesions. Dermatol Clin. Jul 1997;15(3):385-96. [Medline].

  15. Suhonen R, Kuflik EG. Venous lakes treated by liquid nitrogen cryosurgery. Br J Dermatol. Dec 1997;137(6):1018-9. [Medline].

  16. del Pozo J, Pena C, Garcia Silva J, et al. Venous lakes: a report of 32 cases treated by carbon dioxide laser vaporization. Dermatol Surg. Mar 2003;29(3):308-10. [Medline].

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Further Reading

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Keywords

venous-lake angioma, Bean-Walsh angioma, venous varix, senile hemangioma of the lips

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Contributor Information and Disclosures

Author

Jining Wang, MD, Department of Dermatology, Dean Health System
Jining Wang, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Coauthor(s)

Kim Wang, MD, Staff Physician, Department of Pathology, Northwestern University Medical School
Kim Wang, MD is a member of the following medical societies: United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Medical Editor

Timothy McCalmont, MD, Director, UCSF Dermatopathology Service, Professor of Clinical Pathology and Dermatology, Departments of Pathology and Dermatology, University of California at San Francisco
Timothy McCalmont, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society of Dermatopathology, California Medical Association, College of American Pathologists, and United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Rosalie Elenitsas, MD, Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System
Rosalie Elenitsas, MD is a member of the following medical societies: American Society of Dermatopathology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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