Lymphangioma Circumscriptum Presenting as Grouped Blisters

A 69-year-old man with a long history of lymphedema secondary to repeated cellulitis sought medical care for mildly pruritic, nontender, purple nodules that had erupted on the bottom and side of one foot 6 months earlier. Scale surrounded the nodules.

Dr Reynold C. Wong of Sacramento, Calif, considered Kaposi sarcoma and lymphangiomas in the differential. Microscopic examination of a biopsy specimen revealed cystically dilated lymph vessels lined with a single layer of endothelium. The vessels contained a mixture of erythrocytes and lymph. These findings confirmed the diagnosis of lymphangiomas secondary to lymphedema.

A large number of lymphangiomas in a localized area, such as this patient's foot, are associated with widespread lymphatic abnormality; therefore, surgical removal of the lesions is not effective therapy. The patient was advised to wear support stockings for the underlying lymphedema.