Synonyms: senile haemangioma of the lips, venous-lake angioma, Bean-Walsh angioma.

These were first described in 1956 by Bean and Walsh. They are dark blue papules caused by dilatation of venules. They present in sun-exposed areas of the body, particularly the ears of elderly patients. They are of little clinical significance, except that they can be confused with melanomas and pigmented basal cell carcinomas.¹

Epidemiology

They are common in elderly sun-exposed patients. The average age at presentation is 65 years. They are probably more common in men than women.

Presentation

They are usually asymptomatic. Women are more likely to present for cosmetic advice or removal. They are soft and compressible. They often have a smooth surface. They are found most often on lips, face, neck and ears.

Differential diagnosis

• Basal cell carcinoma
• Blue naevus
• Cherry haemangioma
• Kaposi's sarcoma
• Malignant melanoma
• Pyogenic granuloma

Investigations

Diascopy or pressing a glass microscope slide on to the lesion will cause it to blanch as blood empties from the dilated venules. Other lesions in the differential diagnosis will not behave in this way.

Associated diseases

Actinic skin damage often occurs around venous lakes as they have a shared aetiology.

Management

A punch or shave biopsy can be taken to confirm the diagnosis histologically. Laser can also be used.

Prognosis

Excellent. They will not go, but do not progress into more serious lesions such as skin cancer.

Prevention

Avoidance of excessive sun exposure is, as ever, important in prevention of many skin disorders.