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A 70-year-old woman presented su¡ering from lymphoedema of the left inferior limb, and skin lesions located on the vulva and the left thigh. She had been treated with surgery and radiotherapy for cervical squamous cell carcinoma 16 years previously. The lesions started 3 years after therapy and progressed slowly. For the last 4 years, the lesions had been complicated by oozing, lymphorrhoea and several erysipelas, which interfered with her social life. Clinical examination revealed prominent lymphoedema of the left thigh, left leg and vulva involving the major and minor labia. There were also multiple translucent thick-walled vesicles and prominent wart-like lesions in the a¡ected areas (F|g. 1). A skin biopsy demonstrated dilated lymph vessels lined by a single layer of endothelial cells in the upper dermis with epidermal acanthosis and hyperkeratosis. A diagnosis of acquired cutaneous lymphangectasis was made. No gynaecological disease was apparent and further investigations, including a CT scan of the abdomen and pelvis revealed no abnormalities. Laser therapy was performed with the carbon dioxide laser (Sharplan model) under local anaesthesia. The following irradiation parameters were used: hand-piece, skin distance 1 cm, spot size 2 mm, power 15 W, continuous exposure. The pathological tissue was vaporized to the middle dermis. A simple sterile dressing was applied postoperatively. Daily wound care consisted of chlorhexidine gluconate soaks, followed by application of a thin ¢lm of fucidic acid ointment. After a 4-week period with complete wound healing, all lesions were treated with the laser over 5 sessions. No infectious complications occurred during the 19-month follow-up. Recurrences of single pseudovesicles were re-treated with the carbon dioxide laser, using the same procedure as before. At the same time, manual lymphatic draining process associated with elastic contention was performed.

Treatment of Acquired Cutaneous Lymphangiectasis of the Thigh and Vulva with a Carbon Dioxide Laser