Sir,

Cutaneous lymphangioma circumscriptum is a benign, cystic, lymphatic malformation, which may be present at birth or during early childhood [1,2]. It is characterized by asymptomatic lesions in the form of small, transparent vesicles of 2–4 mm clustered in frog-spawn-like patterns, varying in color from light to dark red, depending on the presence of lymphatic fluid and/or hemoglobin degradation components [3]. It may occur in any part of the body yet is most common in the proximal regions.

Dermoscopy is a non-invasive clinical diagnostic technique widely used for the diagnosis of skin tumors and inflammatory and capillary skin diseases [4]. However, it allows the observation of yellowish lacunae surrounded by a pale septum and pale red to bluish lacunae. Hypopyon-like patterns have been described. Histology is consistent with dermal or epidermal lymphatic dilation [5].

Herein, we report a case of the local recurrence of an operated cystic lymphangioma revealed by dermoscopy.

This was a six-year-old female who presented two years previously with two right subcutaneous mammary nodules progressively increasing in size (Fig. 1a), for which she initially consulted a pediatrician. The mammary tumor was initially removed in favor of a cystic lymphatic malformation, which was confirmed on histology.

Figure 1: (a) A subcutaneous mass taking the entire right breast.(b) Grouped purplish-red papules on normal skin with a smooth surface located in the peri-mammary area.

In addition, a six-month follow-up chest CT scan was essentially normal. Two years later, red lesions appeared on the right breast, 3 cm from the old scar. The patient was referred to the dermatology department on suspicion of viral infection. On admission, our examination revealed grouped, purplish-red papules on normal skin with a smooth surface located in the perimammary area (Fig. 1b). Dermoscopy showed a lacunar pattern with sero-hematic content and hypopyon separated by whitish septa (Fig. 2). Our clinical examination aided by dermoscopy allowed us to exclude viral superinfection and detect a local recurrence of her cystic lymphangioma. The diagnosis was confirmed by recent thoracic computed tomography. The patient was then readmitted to pediatric surgeons for further management.

Figure 2: Dermoscopy showing a lacunar pattern with sero-hematic content and hypopyon separated by whitish septa.

REFERENCES

1.Lu L, Yan S, Chen M, Huang X, Su J. Diagnostic values of dermatoscopy and CD31 expression in cutaneous lymphangioma circumscriptum. Front Med (Lausanne). 2021;8:738815.

2.Indrani S, Agarwal S. Cutaneous lesions from lymphangioma circumscriptum. ANZ J Surg. 2017;87:20-1.

3.Zaballos P, Del Pozo LJ, Argenziano G, Karaarslan IK, LandiC, Vera A, et al. Dermoscopy of lymphangioma circumscriptum:A morphological study of 45 cases. Aust J Dermatol. 2018;59:189-93.

4.Martin JM, Bella-Navarro R, Jorda E. Vascular patterns in dermoscopy. Actas Dermo Sifiliogr. 2012;103:357-75.

5.Massa AF, Menezes N, Baptista A, Moreira AI. Ferreira EO. Cutaneous lymphangioma circumscriptum:Dermoscopic features. An Bras Dermatol. 2015;90:262-4.