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LETTER TO EDITOR
Year : 2021  |  Volume : 5  |  Issue : 2  |  Page : 257-259

Dermoscopy of cutaneous lymphangioma circumscriptum: A report of three cases


Department of Dermatology, Venereology and Leprosy, GMC, University of Kashmir, Srinagar, Jammu and Kashmir, India

Date of Submission16-Jun-2020
Date of Decision07-Sep-2020
Date of Acceptance23-Nov-2020
Date of Web Publication26-Aug-2021

Correspondence Address:
Sheema Sheikh
Department of Dermatology, Venereology and Leprosy, GMC, University of Kashmir, Srinagar, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CDR.CDR_86_20

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How to cite this article:
Bhat YJ, Yaseen A, Sheikh S. Dermoscopy of cutaneous lymphangioma circumscriptum: A report of three cases. Clin Dermatol Rev 2021;5:257-9

How to cite this URL:
Bhat YJ, Yaseen A, Sheikh S. Dermoscopy of cutaneous lymphangioma circumscriptum: A report of three cases. Clin Dermatol Rev [serial online] 2021 [cited 2021 Dec 1];5:257-9. Available from: https://www.cdriadvlkn.org/text.asp?2021/5/2/257/324579



Lymphangiomas are congenital lymphatic malformations that can be cystic, capillary, or cavernous, cutaneous lymphangioma circumscriptum (CLC) being the most common type. Dermoscopy is being increasingly used to refine the dermatological diagnosis. It is a simple, rapid, reliable, and noninvasive diagnostic tool that helps visualize morphological details not otherwise visible to the naked eye. Many new and disease-specific dermoscopic patterns are being described.[1] We herein describe the dermoscopic features of three cases with CLC.

Case 1

An 18-year-old female presented with a verrucous plaque composed of multiple clear and hemorrhagic vesicles on the right thigh for 9 years. The vesicles were initially gradually progressive and clear but over a period of last few years turned hemorrhagic, associated with multiple episodes of pain and bleeding. Cutaneous examination revealed a nontender 10 cm × 7 cm sized plaque of a few serous and more numerous blood-tinged fluid-filled vesicles [Figure 1]. No fluctuation, bruit, or thrill was detected. There was no discrepancy in the limb girth on two sides, nor were similar lesions found elsewhere on the body. Routine laboratory investigations were within normal limits. Dermoscopy showed a lacunar pattern with multiple, well-circumscribed roundish areas composed of yellowish lacunae separated by pale septa and reddish-black lacunae that were also separated by pale septa [Figure 2]a and [Figure 2]b. Some of the yellowish lacunae showed red dots corresponding to the sedimented blood.
Figure 1: A verrucous-like plaque of lymphangioma circumscriptum in case 1

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Figure 2: (a) Dermoscopy showing yellowish and reddish-black (white arrow) lacunae separated by pale septa (blue arrow). Few yellow lacunae show reddish-brown dots (red arrow) (polarized mode – Dermlite DL3N, California, USA, ×10). (b) Nonpolarized (×10) dermoscopic view of the lymphangioma

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Case 2

A 21-year-old female also presented with multiple asymptomatic fluid-filled lesions in the left axillary fold since 5 years of age, with no history of pruritus or associated pain. Cutaneous examination showed a 7 cm × 4 cm irregular, scaly plaque consisting of multiple vesicles filled with a straw-colored fluid and occasional hemorrhagic crusts and striae close to the lesion [Figure 3]. Dermoscopy showed yellowish-white lacunae with blood gravitated to their lowest parts in addition to some clear yellow fluid-filled ones separated by pale septa, the former simulating an ocular “hypopyon” [Figure 4].
Figure 3: Irregular plaque consisting of multiple vesicles in case 2

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Figure 4: (a) Dermoscopy showing yellowish lacunae (white arrow) and the “hypopyon-like feature” (red arrow) (polarized mode – Dermlite DL3N, California, USA, ×10). (b) Nonpolarized (×10) view of cutaneous lymphangioma circumscriptum

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Case 3

A 15-year-old girl presented with a 6-year history of multiple, painful fluid-filled lesions over the lower back with occasional episodes of bleeding from the lesion. Examination revealed the presence of a verrucous plaque, 5 cm × 2 cm in size, constituted by multiple hemorrhagic and a few clear fluid-filled satellite vesicles at one end [Figure 5]. Dermoscopy showed the presence of purplish-red lacunae separated by well-defined pale septa [Figure 6]a and [Figure 6]b. Few yellowish clear, irregular lacunae could also be identified. These features pointed to a diagnosis of CLC. Histopathology confirmed the diagnosis of CLC in all these cases [Figure 7].
Figure 5: Hemorrhagic plaque of cutaneous lymphangioma circumscriptum in case 3

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Figure 6: (a) Dermoscopy showing reddish (white arrow) lacunae. Few clear yellow lacunae (red arrow) (polarized mode – Dermlite DL3N, California, USA, ×10). (b) Nonpolarized (×10) dermoscopic view of the lymphangioma. Pale septa (blue arrows) can be well appreciated

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Figure 7: Photomicrographs showing (a) dilated vascular channels in the dermis (H and E, ×40). (b) Vessels lined by a single layer of flattened endothelial cells lining the vessels containing lymph (blue arrows) (H and E, ×400)

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Two dermoscopic patterns have been described for CLC: yellow lacunae surrounded by pale septa and yellow-to-pink lacunae alternating with dark red or bluish lacunae, due to the inclusion of blood.[2] “Hypopyon-like feature” which occurs due to aggregation of blood corpuscles on sedimentation, leading to a color transition from dark to light in some lacunae, occurred in case 2.[3],[4],[5] Dermoscopic features in case 1 indicate the early stage of transition to blood-filled lacunae.

Dermoscopy provides a quick and noninvasive tool to obviate the need for a biopsy in making a diagnosis of this malformation.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Zalaudek I, Argenziano G, Di Stefani A, Ferrara G, Marghoob AA, Hofmann-Wellenhof R, et al. Dermoscopy in general dermatology. Dermatology 2006;212:7-18.  Back to cited text no. 1
    
2.
Arpaia N, Cassano N, Vena GA. Dermoscopic features of cutaneous lymphangioma circumscriptum. Dermatol Surg 2006;32:852-4.  Back to cited text no. 2
    
3.
Jha AK, Lallas A, Sonthalia S. Dermoscopy of cutaneous lymphangioma circumscriptum. Dermatol Pract Concept 2017;7:37-8.  Back to cited text no. 3
    
4.
Gencoglan G, Inanir I, Ermertcan AT. Hypopyon-like features: New dermoscopic criteria in the differential diagnosis of cutaneous lymphangioma circumscriptum and haemangiomas? J Eur Acad Dermatol Venereol 2012;26:1023-5.  Back to cited text no. 4
    
5.
Zaballos P, Del Pozo LJ, Argenziano G, Karaarslan IK, Landi C, Vera A, et al. Dermoscopy of lymphangioma circumscriptum: A morphological study of 45 cases. Australas J Dermatol 2018;59:e189-93.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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