Longstanding smooth blue–red papules

Case presentation

A 75-year-old-man with chronic sun-damaged skin had multiple smooth, blue–red to blue–black papules scattered on his upper trunk (Figure 1), neck and face, including his lips. These were asymptomatic and had gradually increased in number over a 10-year period. Dermoscopy revealed closely aggregated, smooth, blue–red saccules giving the appearance of a mulberry (Figure 2) covered by a patchy milky veil. Wiry telangiectatic vessels forming prominent red mats were present in the surrounding skin. Excision biopsy of one of the lesions showed within the dermis a series of cavernous blood-filled spaces that were lined by a thin rim of endothelium (Figure 3).