What is a Venous Lake?
A Venous Lake is a vascular malformation of venules, typically idiopathic and benign, often seen in elderly patients and more commonly present in sun-exposed areas of the body [1, 2]. Clinically, venous lakes appear as blue-to-violet compressible papules, which are attributed to the dilated venules. Venous Lake is usually asymptomatic but cosmetically undesirable [1, 2].
Venous Lake vs Melanoma
Venous Lake (VL) and Melanoma are different types of skin conditions. VL is a benign vascular malformation commonly seen in elderly patients, often on sun-exposed areas. It's characterized by blue papules and can cause cosmetic concern or occasional bleeding [11], [12]. On the other hand, Melanoma is a type of skin cancer that originates from melanocytes, the cells that give skin its color. It's the most aggressive form of skin cancer and accounts for about 75% of skin cancer deaths [13].
Causes of Venous Lake
It is not known what causes Venous Lakes, but they do present in sun-exposed areas of the body, suggesting longstanding sun exposure could play a role. Additionally, they are more common in the elderly, in which case their development could be associated with ageing. Nevertheless, venous lakes represent a vascular malformation – which is any disorder of the blood vessels – and in the case of venous lakes, a specific disorder of the calibre (size) of the veins is thought to be responsible. This refers to the dilations of venules, small veins that collect blood from the capillaries for transfer into the larger veins [1, 2].
What is Melanoma?
Melanoma is a serious skin cancer that begins in the melanocytes, the cells that produce melanin, the pigment that colours our skin, hair and eyes. It is the most deadly type of skin cancer because, if not caught early enough, it can spread to other parts of the body. Melanoma can develop anywhere on the body, although it most frequently appears on the chest and back in men, and on the legs in women. Melanoma can also form on the face or the neck. Less common but still a possibility is that Melanoma might appear in the eyes, or the intestines and other internal organs [3, 4].
Causes of Melanoma
To date, researchers have yet to fully understand the reasons behind the development of melanoma, which involves a complex interaction between environmental factors and predisposing genetic characteristics. The most significant environmental risk factor is the exposure to ultraviolet radiation (UVR) coming from sun exposure or from sources such as sun beds or tanning beds. UVR manages to damage the DNA inside skin cells instructing them to grow out of control and multiply uncontrollably; to create cancer cells [5, 6].
People who don’t have much melanin in their skin – such as those of European descent or people with albinism – are also at greater risk. So too are those with 50 or more moles on their body, habitual exposure to the sun, a more aggressive strain of Melanoma than the common form that results from sunburn, a weak immune system from a pre-existing medical condition or a recent operation, or a family history of Melanoma (about 10% of people who develop Melanoma have a family history of it) [5, 7].
Venous Lake and Melanoma
Venous Lake and Melanoma are both conditions that affect the skin, but they have distinct characteristics and implications.
Differences
Venus Lake is a benign vascular malformation more frequent in elderly patients and usually occurs in sun-exposed areas of the body. The treatment is frequently requested because of recurrent local bleeding or because of the lesion appearance with an impact on the quality of life [1]. Melanoma is a malignant tumour originating from melanocytes (the cells that produce melanin pigment) that can metastasize to other locations in the body. It is one of the more aggressive forms of skin cancer [8].
Typically, Venus Lakes look like non-structured patterns (globules/clods) with a purple, red or blue colouration. Therefore, dermoscopically, Venus Lakes are useful for differentiating from Melanomas because most Venous Lakess appear non-structured. Melanoma, however, frequently also looks non-structured, although a subset of Melanomas (specifically, those that have a very high expression of a protein called vascular endothelial growth factor or VEGF that stimulates blood vessel formation) can also have the appearance of Venous Lakes on dermoscopy [9].
Treatment of Venous Lake and Melanoma
The approach to treatment between the two conditions also differs. Venous Lake can be treated with laser- and light-based treatments – though the 980 nm diode laser is particularly effective [10]. Melanoma is most commonly treated with scalpel surgery to remove the tumour. If the cancer hasn’t spread to lymph nodes, surgical removal is often the end of treatment. If Melanoma has spread to the lymph nodes, immunotherapy, targeted therapy or chemotherapy may follow, depending on the ‘stage’ and depth of the cancer [8].
Conclusion
While Venous Lake involves distinct vascular changes, the concern with Melanoma is completely different. While Venous Lake is a purely cosmetic condition, Melanoma is a lethal cancer that can be completely invasive and ultimately become life-threatening if it’s not sought out and treated early.