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.^[34]Sodium tetradecyl sulfate may be used with care for off-label treatment of lymphangioma circumscriptum.^[35]

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.

Surgical Care

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.^{[36, 37]}Bleomycin sclerotherapy has been advocated for head and neck lymphangiomas.^[38]

Lymphangioma circumscriptum may be treated with simple electrodessication. It does not always respond to use of the pulsed-dye laser.^[39]

Vaporization with a carbon dioxide laser has been tried with good results.^[40]Other lasers may also be used.^[41]Intra-oral lymphangioma may be treated using fractional carbon dioxide laser.^[42]

Another therapeutic option for lymphangioma circumscriptum is 23.4% hypertonic saline sclerotherapy.^[43]

The use of intralesional OK432 (Picibanil) is a new and effective treatment for macrocystic lesions,^[44]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.^{[45, 46]}

Postoperative vacuum-assisted closure devices may decrease the risks of recurrence and infection.^[47]

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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Media Gallery

A 44-year-old woman with plaque on her forearm since birth that clinically appeared to be typical lymphangioma circumscriptum. Histologically, however, it had features of both hemangioma and lymphangioma.
Close-up demonstrating the clinical morphology to better advantage.
A 16-year-old obese boy with large unilateral verrucous lymphangioma.

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Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Coauthor(s)

Geover Fernandez, MD, FAAD Staff Physician, Department of Dermatology, Rutgers New Jersey Medical School

Geover Fernandez, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for MOHS Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Carrie L Kovarik, MD Assistant Professor of Dermatology, Dermatopathology, and Infectious Diseases, University of Pennsylvania School of Medicine

Carrie L Kovarik, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Lymphangioma Treatment & Management

Medical Care

Surgical Care

Long-Term Monitoring

References

Tables

Contributor Information and Disclosures

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