Detection of superficial lymphatic malformation with dermoscopy and reflectance confocal microscopy

Superficial lymphatic malformation (SLM) is a congenital disorder of the lymphatic channels. It usually appears as clusters of vesicles filled with lymphatic fluid and blood on the skin that resemble frogspawn, making it difficult to distinguish from haemangiomas, angiokeratomas, and pyogenic granulomas. Although pathological results have diagnostic values, the significance of noninvasive examination in the diagnosis and differential diagnosis is also worth exploring.

A 24-year-old female presented with a history of multiple asymptomatic, pink lesions located on the chest since age 10. Histopathological examination was performed, and results informed the diagnosis of SLM. Lesions were detected by dermoscopy and reflectance confocal microscopy (RCM).

Dermoscopy (polarized, 30×) revealed multiple yellowish-red lacunae in a light red background that were separated by pale septa and "hypopyon sign" was observed. RCM displayed a honeycomb pattern and multiple dark cavities in the upper dermal layers separated by thin septa with a few hypo-refractile cells at the periphery that demonstrated slow fluid flow via dynamic scanning.

We described a case of SLM detected by dermoscopy and RCM. Dermoscopic and RCM features may provide a potentially powerful, noninvasive instrument for the recognition and differentiation of SLM.