Acquired Cutaneous Lymphangiectasia: Dermoscopic Evidence from White-Yellowish Lacunae

Case Presentation

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.

Teaching Point

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.