Localized acquired lymphangiectasias after breast surgery: Enhanced non‐invasive diagnosis using dermoscopy and reflectance confocal microscopy

Abstract

Background Acquired lymphangiectasias represent cystic dilatations of the cutaneous lymphatic vessels resulting from damage and/or obstruction of previously normal lymphatics, usually secondary to surgery, radiotherapy, and/or infections. Materials and Methods The clinical, dermoscopic, and confocal microscopy features of three cases of acquired lymphangiectasias occurring after breast surgery are described along with histopathological correlations. Results Polarized dermoscopy revealed in all lesions the presence of well‐circumscribed, white‐yellowish lacunae surrounded by pale septa. In addition, some lesions showed scattered reddish areas and red lacunae. Confocal microscopy showed in the upper dermis numerous, roundish dark cavities separated by thin septa. These features corresponded histopathologically to saccular dilations and ectatic lymphatic vessels lined by a single layer of endothelial cells in the papillary/reticular dermis. Conclusion The use of non‐invasive diagnostic techniques may be addressed to an enhanced non‐invasive diagnosis of acquired lymphangiectasias by showing peculiar features, thus avoiding the need for skin biopsy.

Acquired Cutaneous Lymphangiectasia: Dermoscopic Evidence from White-Yellowish Lacunae

“…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.…”

A case of lymphangioma circumscriptum with new reflectance confocal microscopy findings

“…Some small bright elements (8–9 μm) correspond to lymphoid cells may be seen within cavities. No blood flow is seen 4‐6 …”

Dermoscopic features of cutaneous metastases from breast carcinoma: A report of three Indian patients

“…6,7 We also noted yellow-white lacunae and smaller red lacunae separated by thin septae, the dermoscopic features described for lymphangiectasias, probably correlating with the lympho-vascular invasion by tumour cells; these features have not been described for breast carcinoma cutaneous metastases before to our knowledge [Table 1]. 8,9 The dermoscopic findings of breast carcinoma cutaneous metastases appear to be relatively non-specific, and can resemble benign as well as malignant conditions. However, some dermoscopic features such as linear branched vessels, and features resembling those of melanoma or lymphangiectasias can raise the suspicion of a metastatic deposit in the appropriate setting.…”