A 54-year-old woman with no relevant past medical history consulted for an asymptomatic lesion that been growing progressively on her upper lip for 4 years. She reported no systemic symptoms and denied trauma, cosmetic procedures, application of topical products, and consumption of oral drugs.

The skin examination showed an irregular, well-delimited, normal-colored, indurated, mobile, nonpulsatile nodule on the left upper lip (Fig. 1A). There were no oral mucosal lesions and the locoregional lymph nodes were not enlarged.

Figure 1

(0.19MB).

We decided to perform a soft-tissue ultrasound before biopsy. The findings showed a solid, ovoid, well-defined, heterogeneous lesion with a diameter of 15mm and abundant arterial and venous flow. A subsequent computed tomography scan of the supra-aortic arteries showed a hypervascular lesion with intense arterial enhancement that was irrigated by the labial branch of the facial artery and the superior alveolar artery (branch of the maxillary artery) (Figs. 1B-D). Integration of the clinical and radiological findings (mainly the CT images) helped to confirm a diagnosis of caliber-persistent labial artery. The patient was referred to the vascular neuroradiology department for treatment.

Because of the risk of complications, skin or soft-tissue ultrasound should be requested before performing a skin biopsy in patients with an indurated lip nodule. Three-dimensional reconstructions are of great diagnostic value in vascular diseases and dermatological oncology.