A 40 year old man presented with a flat 1 cm x 1 cm scaly, itchy clack mole on the front of thigh. Examination did reveal any inguinal lymphadenopathy. The best course of management would be
Correct Answer: Exicisional biopsy
Description: Lymphangiomas are dilated dermal lymphatics that 'blister' onto the skin surface. The fluid is usually clear but may be blood-stained. In the long term, lymphangiomas thrombose and fibrose, forming hard nodules that may raise concerns about malignancy. If lymphangiomas are <5cm across, they are termed lymphangioma circumscriptum, and if they are more widespread, they are termed lymphangioma diffusum. If they form a reticulate pattern of ridges then it has been termed lymphoedema ab igne. Lymphangiomas frequently weep (lymphorrhoea, chylorrhoea), causing skin maceration, and they act as a poal for infection. Protein-losing diarrhoea, chylous ascites, chylothorax, chyluria and discharge from lymphangiomas suggest lymphangectasia (megalymphatics) and chylous reflux. Ulceration, non-healing bruises and raised purple-red nodules should lead to suspicion of malignancy. Lymphangiosarcoma was originally described in postmastectomy oedema (Stewa-Treves' syndrome) and affects around 0.5% of patients at a mean onset of 10 years. However, lymphangiosarcoma can develop in any long-standing lymphoedema, but usually takes longer to manifest (20 years). It presents as single or multiple bluish/red skin and subcutaneous nodules that spread to form satellite lesions, which may then become confluent. Thediagnosis is usually made late and confirmed by excision biopsy. Amputation offers the best chance of survival but, even then, most patients live for less than 3 years. It has been suggested that lymphoedema leads to an impairment of immune surveillance and so predisposes to other malignancies, although the causal association is not as definite as it is for lymphangiosarcoma. Ref : Bailey and love 27th edition Pgno : 998
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