How Would You Diagnose This Lesion?

Author:
David L. Kaplan, MD—Series Editor

Citation:
Kaplan DL. How would you diagnose this lesion? Consultant. 2017;57(6):353-354.

This 16-year-old girl presented for evaluation of an enlarging lesion over the left posterior shoulder. It had appeared shortly after birth and had been excised. She had been told that the lesion was benign, but she does not remember the diagnosis. She would like to have it removed.

Answer on next page

Answer: Lymphangioma circumscriptum

This lesion was a recurrent lymphangioma circumscriptum. Lymphangioma circumscriptum is a benign lymphatic ectasia with 2 components: a clinically apparent dermal vascular component, and a not-so-apparent deep subcutaneous cisternal structure. Although it is characterized by translucent, pink-red vesicle bundles with thin membranes that are sometimes filled with blood, the vesicles have clear edges, and they can be scattered or can develop in groups.

Lymphangiectasia typically features only clear blebs, while a hemangioma would only be vascular, unlike this patient’s lesion. The lesions of molluscum contagiosum are umbilicated papules, unlike what is seen here. And angiokeratomas typically have only a vascular or erythematous appearance.

Although the main objective of treatment of lymphangioma circumscriptum is for cosmetic purposes, treatment for associated constant lymph and blood leakage, pain, edema, and persistent infections is also relevant. Many successful treatments—including surgical excision, incision and drainage, injection of sclerosing agents, electrocautery, cryotherapy, radiotherapy, and laser therapy—have been reported. Among these methods, surgical treatment is the most common, with the lowest associated recurrence rate.

David L. Kaplan, MD, is a clinical assistant professor of dermatology at the University of Missouri–Kansas City School of Medicine in Kansas City, Missouri, and at the University of Kansas School of Medicine in Kansas City, Kansas. He practices adult and pediatric dermatology in Overland Park, Kansas.