Clinically, cutaneous lymphangioma circumscriptum (CLC) (Figure 1A and Figure 2A) should be differentiated from other vascular and lymphatic lesions, such as hemangiomas, angiokeratomas, lymphangioendotheliomas, and angiosarcomas,1- 3 as well as from warts, molluscum contagiosum, condyloma acuminata, and hidrocystoma.4- 7 The dermoscopic features of CLC demonstrate 2 distinct patterns8: (1) yellow lacunae surrounded by pale septa without inclusion of blood (Figure 1B) and (2) yellow to pink lacunae alternating with dark-red or bluish lacunae due to the inclusion of blood (Figure 2B). In pattern 2, the blood cells precipitate, giving rise to 2-tone lacunae. Histopathologically, pattern 1 is characterized by dilated dermal and/or subcutaneous lymphatic vessels, which are filled with lymphatic fluid (Figure 1C), while pattern 2 also includes variable concentrations of red blood cells (Figure 2C). Although there are rare circumstances in which CLC may be dermoscopically indistinguishable from hemangiomas, the majority of hemangiomas can be delineated by homogeneous red lacunae (Figure 3).
SCOPE A, Amini S, Kim NH, Zell DS, Oliviero MC, Rabinovitz HS. Dermoscopic-Histopathologic Correlation of Cutaneous Lymphangioma Circumscriptum. Arch Dermatol. 2008;144(12):1671-1672. doi:10.1001/archderm.144.12.1671