A venous lake is a common, benign vascular lesion that appears as a small, dilated blood vessel near the skin’s surface. These lesions are most frequently found on sun-exposed areas like the lips, ears, face, and neck, particularly in older adults. While they are medically harmless, their dark appearance often causes concern regarding the potential for rupture or serious bleeding. As a collection of blood vessels, a venous lake is vulnerable to injury.
Identifying a Venous Lake
A venous lake typically presents as a solitary, soft, dome-shaped spot, ranging in color from dark blue to purple or violaceous. Their size is generally small, usually between two millimeters and one centimeter in diameter. The underlying cause is the dilation of venules, which are tiny veins just beneath the skin. These lesions are compressible; applying gentle pressure causes the blood to drain out temporarily, making the spot flatten before the blood slowly refills it. Venous lakes are asymptomatic unless irritated or injured, but medical evaluation is often recommended to rule out more serious conditions, such as nodular melanoma.
The Likelihood of Bleeding and Rupture
A venous lake can rupture, but this is almost always a result of minor trauma, not a spontaneous event. Since the lesion is a thin-walled, dilated vessel close to the surface, it is fragile and vulnerable to external forces. Common causes of rupture include accidental lip biting, friction from shaving, or other minor impacts. When bleeding occurs, it can appear profuse and alarming due to the lesion’s superficial location. However, the bleeding is rarely medically serious or life-threatening since the blood originates from a vein, not an artery. Venous bleeding is characterized by a steady, continuous flow of dark red or maroon blood, contrasting sharply with arterial bleeding, which is bright red and spurts rhythmically.
Emergency Management of a Bleeding Lesion
If a venous lake begins to bleed, the immediate goal is to apply direct, firm pressure to the site to encourage clotting. Use a clean cloth, sterile gauze, or a bandage and press down continuously. Avoid lifting the compress to check the wound, as this can disrupt clot formation. The area should be elevated above the level of the heart, if possible, to help reduce blood flow; for facial bleeding, keeping the head elevated is usually sufficient. Continue applying pressure for at least 10 to 15 minutes without interruption. Immediate medical attention is required if the bleeding does not stop after this period or if the blood loss appears excessive.
Professional Treatment and Removal
Since venous lakes are benign, treatment is typically elective, sought mainly for cosmetic reasons or if the lesion bleeds repeatedly. Laser treatment is considered the gold standard for management because it targets the blood within the lesion with high precision. Specific lasers, such as the Long Pulsed Nd:YAG or Pulsed Dye Laser, are commonly used. The light energy is absorbed by the blood, converting it to heat which damages and collapses the dilated vessel. Other techniques include cryotherapy and surgical excision for larger lesions, which are usually quick and performed in an outpatient setting.