A 70-year-old retired farmer seeks evaluation for 2 "lumps" on his skin. One is on his lower lip and the other is on his ear. These have been present for "a while" and seem to be getting larger. He recently saw a television show on skin cancer and thought he should get these checked. He has no other health concerns.
His vital signs are normal. The lip lesion is shown in the photograph below. The lesion reduces in size when compressed.

What is the most likely diagnosis?

Question

A 70-year-old retired farmer seeks evaluation for 2 "lumps" on his skin.  One is on his lower lip and the other is on his ear.  These have been present for "a while" and seem to be getting larger.  He recently saw a television show on skin cancer and thought he should get these checked.  He has no other health concerns.
His vital signs are normal.  The lip lesion is shown in the photograph below.  The lesion reduces in size when compressed.

What is the most likely diagnosis?

Quizplus · Accepted Answer

This patient has a venous lake. Venous lakes are benign lesions often seen on the lips and ears of elderly patients. They appear as gray-blue to purple papulonodules and represent dilated venules in the superficial dermis. An important diagnostic feature of venous lakes is that they disappear when compressed. Venous lakes bleed easily following minor trauma. They are brought to a physician's attention because of episodic bleeding or cosmetic concerns. Electrosurgery can be used if the lesion causes a bleeding problem or is cosmetically unacceptable. An alternate treatment is the pulsed dye vascular laser, which can remove these lesions without scarring. (Choice A) Basal cell carcinoma presents as a slow-growing papule with pearly, rolled borders and overlying telangiectasia. Although basal cell carcinomas can involve the lip, it is often the upper lip that is involved. Basal cell carcinoma (Choice B) Blue nevi are smooth-surfaced, dome-shaped melanocytic papules that develop from macules and tend to be < 1 cm in diameter. They do not disappear with compression and do not usually appear on the face, ears, or lips. Instead, they are often found on the buttocks, sacral area, and dorsum of the hands and feet. Blue nevi (Choice C) Nodular melanoma appears as a darkly pigmented, pedunculated, or polypoid nodule that remains firm and does not disappear with compression. (Choice D) Squamous cell carcinoma of the lip occurs predominantly on the lower lip. Lesions can present as ulcers, nodules, or indurated white plaques. Educational objective: Venous lakes are benign lesions commonly seen on the lips and ears of elderly patients. They appear as gray-blue to purple papulonodules that disappear when compressed. They are frequently brought to physicians' attention because of cosmetic concerns or a history of periodic bleeding. __________ References: Evaluation and treatment of venous lakes with the 595-nm pulsed-dye laser: a case series. (http://www.ncbi.nlm.nih.gov/pubmed/17244345)

A 70-Year-Old Retired Farmer Seeks Evaluation for 2 "Lumps" on His