A 71-year-old woman, with a personal history of a left radical mastectomy and locoregional radiation therapy for breast cancer 20 years ago, was referred for assessment. She presented secondary chronic upper limb lymphedema and asymptomatic flesh-colored papulovesicles on the left axillary area ( Figure 1 ) that appeared 6 months ago. On dermoscopy, lesions presented well-demarcated red-orange lacunae surrounded by white lines ( Figure 2 ). Histopathology showed multiple ectatic lymphatic vessels in the papillary dermis ( Figure 3 ). Thus, a diagnosis of acquired cutaneous lymphangiectasia was made.
Figure 1 .
Multiple thin-walled papulovesicles on the left axillary area.
Figure 2 .
Dermoscopy revealing a vascular pattern with well-circumscribed yellowish lacunae surrounded by pale septa.
Figure 3 .
Histopathology revealing ectatic vessels in papillary dermis lined by a single layer of endothelial cells.
Acquired cutaneous lymphangiectasia (ACL) are dilatations of surface lymphatic vessels, following lymphatic damage after surgery or radiotherapy, specially related with breast cancer [ 1 ] . Often described as “frog spawn”, ACL presents as multiple asymptomatic translucent vesicular lesions, resembling a lymphangioma circumscriptum. Dermoscopy shows a vascular pattern with yellow-orange lacunae surrounded by white septa [ 2 ] . Although ACL are considered benign disorders, histopathological diagnosis is needed to rule out different disorders, including cutaneous metastases from previous cancers.
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- Localized acquired lymphangiectasias after breast surgery: Enhanced non-invasive diagnosis using dermoscopy and reflectance confocal microscopy Verzì AE, Lacarrubba F, Tedeschi A, Micali G. Skin Res Technol.2020;26(2):205-208. CrossRef PubMed