What Is Your Diagnosis? Acquired Cutaneous Lymphangiectasia

A 56-year-old white woman with a history of stage III carcinoma of the right breast and subsequent right mastectomy, chemotherapy, radiotherapy, and a transverse rectus abdominis myocutaneous flap breast reconstruction 7 years prior presented with new skin lesions of several months’ duration that had slowly developed on her right axilla and under her reconstructed right breast. The lesions were not painful and did not bleed, drain, or itch. One year prior to presentation she visited her primary care physician with a concern of back pain, and a bone scan revealed a lesion on the left ninth rib that was resected and determined to be benign on pathologic examination. She denied any further symptoms such as new breast lumps or masses. She was otherwise healthy with a history of hypertension, hyperlipidemia, bladder spasms, and gastroesophageal reflux. Her medications included esomeprazole, oxybutynin, and letrozole. Physical examination revealed multiple clusters of small, flesh-colored, fluid-filled vesicles ranging from 2 to 6 mm that were located just below the inframammary fold of her reconstructed right breast. There was no notable lymphedema, no palpable lymphadenopathy, and no breast masses or subcutaneous nodules. A 4-mm punch biopsy was obtained.