Dermatology: Practical and Conceptual 54 Observation | Dermatol Pract Concept 2018;8(1):12 DERMATOLOGY PRACTICAL & CONCEPTUAL www.derm101.com Case Report A 62-year-old woman presented with complaints of asymp- tomatic tortuous purplish to black swellings on the under- surface of the tongue for 8 months (Figure 1). She first noticed a few red to purple small outpouching of the veins on the undersurface of tongue. The lesion has increased pro- gressively in due course of time. On mucosal examination, dilated tortuous vessels were seen along the lateral portions of undersurface of the tongue. Examination of the skin, hair and other mucosal surfaces were normal. There was no his- tory of bleeding from the site and there was no evidence of any associated systemic disease. Dermoscopy [polarized, 10X] showed red lacuna with whitish veil at a few places, and based on location, age, clinical and dermoscopic appearance, it was diagnosed as lingual varicosities. Discussion Caviar tongue, also known as lingual varicosities and sublin- gual varices, is considered as a physiological change associ- ated with advancing age, usually developing due to senile elas- tolytic degeneration of sublingual veins [1,2]. It is mostly seen at the undersurface of the tongue along the sublingual glands where the mucosal surface is thin and translucent which permits visualisation of submucosal vascular structures [1]. Mucoscopy in lingual varicosities Abhijeet K. Jha1, M. D. Zeeshan1, Amar K. Jha Amar1 1 Department Of Skin & VD, Patna Medical College and Hospital, Patna, Bihar, India Key words: mucoscopy, dermoscopy, lingual varicosity, caviar tongue Citation: Jha AK, Zeeshan MD, Jha Amar AK. Mucoscopy in lingual varicosities. Dermatol Pract Concept. 2018;8(1):54-55. DOI: https://doi. org/10.5826/dpc.0801a12 Received: September 22, 2017; Accepted: October 26, 2017; Published: January 31, 2018 Copyright: ©2018 Jha et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: None. Competing interests: The authors have no conflicts of interest to disclose. All authors have contributed significantly to this publication. Corresponding author: Abhijeet Kumar Jha, MD, Department of Skin &VD, Patna Medical College and Hospital, Patna, Bihar, India. Email: drabhijeetjha@gmail.com Figure 1. Tortuous purplish to black swellings on the undersurface of the tongue. [Copyright: ©2018 Jha et al.] Observation | Dermatol Pract Concept 2018;8(1):12 55 lowest part of the lacuna, resulting in an appearance similar to the so-called “hypopyon” of the eye, a new “dermatologic” metaphoric term has been used to describe this peculiar fea- ture as half-and-half lacuna [5]. The patient was counseled about the benign nature of the diseaseand that is common in the elderly; no treatment was given. Sclerotherapy, surgery, or photocoagulation with high intensity diode laser or NdYag laser has been tried in few lesions on unusual locations, such as the lips or buccal mucosa. In conclusion, dermoscopy can be an auxiliary tool in the diagnosis of lingual varicosities. To the best of our knowledge, this is the first report on dermoscopy of caviar tongue. References 1. Lazos JP, Piemonte ED, Panico RL. Oral varix: a review. Gerodon- tology. 2015;32:82-89. 2. Kocsard E, Ofner F, d’Abrera VSE. The histopathology of caviar tongue ageing changes of the undersurface of the tongue. Derma- tologica. 1970;140:318–322. 3. Campos-do-Carmo G, Ramos-e-Silva M. Dermoscopy: basic con- cepts. Int J Dermatol. 2008;47:712–719. 4. Zaballos P, Llambrich A, Cuéllar F, Puig S, Malvehy J. Dermoscopic findings in pyogenic granuloma. Br J Dermatol. 2006;154:1108– 1111. 5. Jha AK, Lallas A, Sonthalia S. Dermoscopy of cutaneous lymphan- gioma circumscriptum. Dermatol Pract Concept. 2017;7(2):8. On dermoscopy, dark-blue lacunae (Figure 2) suggest vessel thrombosis and red lacunae suggest absence of it [2]. Dermoscopically, hemangiomas also show red-bluish lacunae but lack the sharp dermarcation seen in angiokeratoma of Fordyce [3]. Pyogenic granuloma reveals whitish veils, but lack the red-blue lacunae [4]. Cutaneous lymphangioma cir- cumscriptum displays two distinct patterns: yellow lacunae surrounded by pale septa without inclusion of blood and yellow to pink lacunae alternating with dark-red or bluish lacunae, due to the inclusion of blood. A few lacunae con- tained blood, which was characteristically accumulated in the Figure 2. Dermoscopy [polarized, 10X] showed red lacuna with whitish veil at few places. [Copyright: ©2018 Jha et al.]