Courses

Lymphangiomas, perhaps more correctly called lymphatic malformations, may be confined to subcutaneous structures but often there is a significant cutaneous component. Whilst the deep cavernous component may cause significant deformity and disability it is often the cutaneous component which causes the most problems symptomatically. The cutaneous component usually presents at birth or in early life as numerous clear vesicles. They may become verrucous and the vesicles may be blood filled, either permanently or intermittently. The thin walled vesicles are easily traumatised, ooze serum and act as portals for the entry of infection. Symptomatic areas maybe small or extensive areas of skin may be affected. Local excision is usually followed by new areas becoming manifest. Carbon dioxide laser vaporisation of the epidermis and papillary dermis can be used to remove the superficial component of a lymphatic malformation. The wound repithelialises over 10-14 days. Erythema settles over many months to leave usually normal texture skin which is stable and symptom free. Vermcous areas may heal with some textural change. Symptomatic relief is usually long term but areas can be retreated if necessary. Alternatives to carbon laser vaporisation are pulsed dye laser treatment if the vesicles contain blood and infrared coagulation or electrosurgery if there is a symptomatic bulky intracutaneous component and surface textural change will not compromise the result i.e. intraoral or vulva lesions. Patients with symptomatic cutaneous lymphatic malformations can usually be helped by treatment and their quality of life improved significantly. lymphangiomas I C1-3 1 Actinic keratoses: Treatment with C02 laser