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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
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.
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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.