This lovely patient has a venous lake that she has been dealing with for many years. It has been removed previously (just shaved off, not excised as we do here) and it reoccured.
A venous lake is most commonly seen on the tops of the ears and the bottom lip, areas that see a lot of sun. A superficial vein dilates because of sun exposure which thins the walls of the blood vessel, making the vein dilate and create a “lake” or a larger space. Veins are not lines with muscle, like arteries are, so they are more prone to loosen and dilate like this. A trick to tell if it is a venous lake, is to compress the area/ push the area and the blue color will disappear, but when you remove the compression you will see the blue color return.