Acquired Cutaneous Lymphangiectasia of Vulva: A Novel Dermoscope Finding.

Abstract

A 61-year-old woman presented with a 1-year history of multiple, oozy, raised pruritic lesions over the genitalia. Four years back, she had undergone radical hysterectomy followed by loco-regional radiotherapy for her stage IIA carcinoma cervix. On physical examination, she had multiple, grouped, translucent, thin-walled vesicles resembling “frogspawn” on the bilateral labia majora [Figure 1]. Histopathological examination showed a hyperkeratotic epidermis with multiple dilated lymphatic channels in the superficial and deep dermis. Dermoscopy (Dermlite 4) revealed clustered, translucent, reddish-white lacunae surrounded by whitish septa. Few lacunae showed radially arranged, hairpin-like vessels [Figure 2]. The features were consistent with acquired cutaneous lymphangiectasia of vulva (ACLV). Radiofrequency ablation of the lesions was performed and she was under regular follow-up.Figure 1: Multiple, grouped, translucent to flesh-colored, fluid-filled vesicles - ”frogspawn appearance” on labia majoraFigure 2: Dermoscopy (Dermlite 4: Polarized view, 10× magnification) showing clustered, translucent, reddish-white lacunae surrounded by whitish septa (yellow circle). Few lacunae showed radially arranged hairpin-like vessels (black circles)ACLV is a rare entity, which occurs secondary to conditions like trauma, surgery, keloids, radiation, scleroderma, pregnancy, malignancies, Crohn’s disease, or infections like erysipelas, tuberculosis, filariasis, and lymphogranuloma venereum. These conditions cause destruction of lymph nodes and impair lymphatic flow thereby resulting in the accumulation of lymph in dermal lymphatics producing vesicles.[1] The differential diagnosis includes lymphangioma circumscriptum, syringoma, condyloma, herpes, warts, molluscum contagiosum, and benign hemangioendothelioma.[12] Errichetti et al.[3] in their dermoscopy of ACLV reported a vascular pattern with well-demarcated, round to oval red lacunae surrounded by white areas/lines with several punctiform and a few irregular vessels. In addition, we have observed radially arranged hairpin-like vessels in our case. In dermoscopy, similar hairpin-like vessels are found in seborrheic keratosis, keratoacanthoma, squamous cell carcinoma, amelanotic melanoma, superficial basal cell carcinoma (BCC), nodular BCC, eccrine poroma, porocarcinoma, and pilomatrixoma.[4] We report this case for the novel dermoscopic finding. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.