Lymphangioma Treatment & Management

Updated: Apr 23, 2019
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Medical Care

No medical care has been proven effective for lymphangiomas. Lymphangioma is not responsive to radiation therapy or steroids. However, propranolol represents a potential option, which may be of benefit even for intractable diffuse lymphangiomatosis. [27] Sodium tetradecyl sulfate may be used with care for off-label treatment of lymphangioma circumscriptum. [28]

Antibiotics are given for secondary cellulitis.

In the case of lymphangioma circumscriptum, severe recurrent cellulitis may warrant inpatient care at times, especially in patients who are immunocompromised.

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Surgical Care

The preferred treatment for lymphangiomas is complete surgical excision. [29] On the basis of the Whimster hypothesis, the large subcutaneous cisterns should be removed to prevent the lesion from resurfacing.

Local recurrences are common in lymphangiomas. Adequate excision of lymphangiomas can be difficult and, at times, unfeasible. This problem is the main reason for the high recurrence rate. Tumors that are confined to the superficial dermis are more amenable to surgical excision, which is associated with a high rate of success.

The use of other treatment modalities has been advocated; these include cryotherapy, sclerotherapy, cautery, and radiofrequency therapy. [30, 31] Bleomycin sclerotherapy has been advocated for head and neck lymphangiomas. [32]

Lymphangioma circumscriptum may be treated with simple electrodessication. It does not always respond to use of the pulsed-dye laser. [33]

Vaporization with a carbon dioxide laser has been tried with good results. [34] Other lasers may also be used. [35] Intra-oral lymphangioma may be treated using fractional carbon dioxide laser. [36]

Another therapeutic option for lymphangioma circumscriptum is 23.4% hypertonic saline sclerotherapy. [37]

The use of intralesional OK432 (Picibanil) is a new and effective treatment for macrocystic lesions, [38] but the response of microcystic or cavernous lesions to OK-432 has been disappointing and surgery remains the most effective treatment for these microcystic and cavernous lesions. [39, 40]

Postoperative vacuum-assisted closure devices may decrease the risks of recurrence and infection. [41]

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Long-Term Monitoring

Patients with lymphangiomas should be monitored and treated for cellulitis, especially those with ruptured vesicles, which provide a portal of entry for infection. Regular skin examination should be included in the follow-up treatment to evaluate recurrence and the response to treatment.

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