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Dermoscopic image of radiotherapy associated benign lymphangiomatous papules
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  1. Kelvin Truong1,2,
  2. Shaun Chou2,3 and
  3. Charmaine Vanessa Suobiron Chamberlin1
  1. 1Department of Dermatology, Westmead Hospital, Westmead, New South Wales, Australia
  2. 2Sydney Medical School Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
  3. 3Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, New South Wales, Australia
  1. Correspondence to Dr Kelvin Truong; kelvin.truong{at}sydney.edu.au

https://doi.org/10.1136/bcr-2023-257598

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    Description

    A woman in her 50s presented with a 1-year history of irritated, flat-topped vesicles and papules with focal hyperkeratosis on the right lower outer breast (figure 1). Dermoscopic evaluation revealed a cluster of clear to slightly erythematous lacunae separated by white septae with underlying vasculature, focal hyperkeratosis and a background of scattered homogeneous pigmentation (figure 2). These dermoscopic features are usually attributed to benign lymphatic malformations. The lesion developed within an area treated 10 years prior with wide local excision and adjuvant radiotherapy for invasive lobular carcinoma. A skin punch biopsy showed a vascular lesion in the superficial dermis with plump endothelial cells but without nuclear overlapping, cytological atypia or mitotic activity (figure 3). There was epidermal collarette around the main vascular channels. Immunohistochemistry staining was positive for D2-40 and Ki-67, which stained occasional lesional endothelial cells. These findings are consistent with benign lymphangiomatous papules, a rare sequela of radiotherapy.1

    Figure 1
    Figure 1

    Flat-topped vesicles and papules with focal hyperkeratosis on the right lower outer breast.

    Figure 2
    Figure 2

    Dermoscopic evaluation revealed a cluster of clear to slightly erythematous lacunae separated by white septae with underlying vasculature, focal hyperkeratosis and a background of scattered homogeneous pigmentation.

    Figure 3
    Figure 3

    The skin shows a vascular lesion comprising dilated, thin-walled vascular channel within the superficial dermis. The endothelial cells are plump but there is no nuclear overlapping, cytological atypia or mitotic activity. Fibrin and small amount of red blood cells are seen in the lumen. There is epidermal collarette around the main vascular channels.

    Learning points

    • Benign lymphangiomatous papules are a rare sequela of radiotherapy.

    • When evaluating lesions present in a previously irradiated area, differential diagnoses may include the recurrence of a malignant lesion, squamous cell carcinoma and atypical vascular lesions.

    • Dermoscopy of benign lymphangiomatous papules may feature a cluster of clear to slightly erythematous lacunae separated by white septae with underlying vasculature, focal hyperkeratosis and a background of scattered homogeneous pigmentation.

    Ethics statements

    Patient consent for publication

    Reference

    1. ↵
      1. Corradini AG,
      2. Asioli S,
      3. Morandi L, et al
      . Post-radiotherapy vascular lesions of the breast: immunohistochemical and molecular features of 74 cases with long-term follow-up and literature review. Histopathology 2020;77:293–302. doi:10.1111/his.14090
      OpenUrl

    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: KT, SC and CVSC. The following authors gave final approval of the manuscript: KT, SC and CVSC.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.