Derm Dx: Dark papules after stage IA melanoma - Clinical Advisor

Derm Dx: Dark papules after stage IA melanoma

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  • Venous Lake 1_0612 Derm Dx

  • Venous Lake 2_0612 Derm Dx

  • Venous Lake 3_0612 Derm Dx

  • Venous Lake 4_0612 Derm Dx

A 68-year-old white male with a history of stage IA melanoma presents for his annual full body skin exam. He complains of dark papules on his left ear. The lesions are asymptomatic.

On exam, you notice a well-healed scar on his left upper back at the site of melanoma excision. You also note several dark blue macules and papules on his left ear helices, which disappear with pressure. What’s your diagnosis?

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A venous lake is a small, dark blue to purple easily compressible bleb, caused by chronic sun damage. These types of lesions occur most commonly on the ear and lower lip, but may also be found on the face, neck,...

Submit your diagnosis to see full explanation.

A venous lake is a small, dark blue to purple easily compressible bleb, caused by chronic sun damage. These types of lesions occur most commonly on the ear and lower lip, but may also be found on the face, neck, forearms and dorsal hands. 

When venous lakes occur on the ears, they are more frequently located on the left side of the body due to chronic sun exposure during automobile driving. Venous lakes can be emptied of their blood contents by applying firm pressure. Histologically, a venous lake is a large dilated venule in the dermis of sun-damaged skin. 

Diagnosis

Venous lake diagnosis is based on the clinical appearance of a bluish bleb that can be compressed of its contents. When the diagnosis is in doubt, biopsy may be performed.

Melanomas have a blue-black appearance similar to a venous lake; however, a melanoma is not compressible.

Various subtypes of angiokeratomas exist. Similar to venous lake, they are blue or purple and may appear black. However, angiokeratomas have a more hyperkeratotic surface and are poorly or non-compressible (see the Derm Dx on angiokeratomas).

Lymphangioma circumscriptum consist of dilated lymphatic channels and appear as clusters of translucent or hemorrhagic vesicles; they have been compared to frog’s eggs. 

Treatment and prognosis           

Treatment options include electrosurgery, laser surgery, or liquid nitrogen.  In this case, the patient only required reassurance that he did not have a melanoma. 

Adam Rees, MD, is a graduate of the University of California Los Angeles School of Medicine and a resident in the Department of Dermatology at Baylor College of Medicine in Houston.

References:

1. Bolognia J, Jorizzo JL, Rapini RP. “Chapter 106: Other Vascular Disorders.” Dermatology. St. Louis, Mo.: Mosby/Elsevier, 2008.

2. James WD, Berger TG, Elston DM et al. “Chapter 28: Dermal and Subcutaneous Tumors.” Andrews’ Diseases of the Skin: Clinical Dermatology. Philadelphia: Saunders Elsevier, 2006.

 

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