Dermatology: Practical and Conceptual Dermatology Practical & Conceptual Image Letter | Dermatol Pract Concept. 2021;11(3):e2021062 1 Acquired Cutaneous Lymphangiectasia: Dermoscopic Evidence from White-Yellowish Lacunae Nicolás Silvestre-Torner1, Adrián Imbernón-Moya1, Marta Martínez-García1, Fernando Burgos- Lázaro2 1 Department of Dermatology. Hospital Universitario Severo Ochoa. Avenida de Orellana, Leganés, Madrid, Spain. 2 Department of Pathology. Hospital Universitario Severo Ochoa. Avenida de Orellana, Leganés, Madrid, Spain. Key words: Lymphangiectasia, Dermoscopy, Lymphedema, Breast cancer Citation: Silvestre-Torner N, Imbernón-Moya A, Martínez-García M, Burgos-Lázaro F. Acquired cutaneous lymphangiectasia: dermoscopic evidence from white-yellowish lacunae. Dermatol Pract Concept. 2021;11(3):e2021062. DOI: https://doi.org/10.5826/dpc.1103a62 Accepted: December 10, 2020; Published: July 8, 2021 Copyright: ©2021 Silvestre -Torner et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License BY-NC-4.0, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing interests: The authors have no conflicts of interest to disclose. Authorship: All authors have contributed significantly to this publication. Corresponding author: Nicolás Silvestre Torner, Department of Dermatology, Hospital Universitario Severo Ochoa, Avenida de Orellana, Leganés, Madrid, Spain, Plaza General Vara de Rey 11, 4G. Email: nicolassilvestretorner@gmail.com  Case Presentation A 71-year-old woman, with a personal history of a left radical mastectomy and locoregional radiation therapy for breast cancer 20 years ago, was referred for assessment. She presented secondary chronic upper limb lymphedema and asymptomatic flesh-colored papulovesicles on the left axillary area (Figure 1) that appeared 6 months ago. On dermoscopy, lesions presented well-demarcated red-orange lacunae surrounded by white lines (Figure 2). Histopathology showed multiple ectatic lymphatic vessels in the papillary dermis (Figure 3). Thus, a diagnosis of acquired cutaneous lymphangiectasia was made. Teaching Point Acquired cutaneous lymphangiectasia (ACL) are dilatations of surface lymphatic vessels, following lymphatic damage after surgery or radiotherapy, specially related with breast cancer [1]. Often described as “frog spawn”, ACL presents as multiple asymptomatic translucent vesicular lesions, resem- bling a lymphangioma circumscriptum. Dermoscopy shows a vascular pattern with yellow-orange lacunae surrounded by white septa [2]. Although ACL are considered benign disorders, histopathological diagnosis is needed to rule out different disorders, including cutaneous metastases from previous cancers. 2 Image Letter | Dermatol Pract Concept. 2021;11(3):e2021062 Figure 1. Multiple thin-walled papulovesicles on the left axillary area. Figure 2. Dermoscopy revealing a vascular pattern with well-cir- cumscribed yellowish lacunae surrounded by pale septa. Figure 3. Histopathology revealing ectatic vessels in papillary der- mis lined by a single layer of endothelial cells. References 1. Valdés F, Peteiro C, Toribio J. Acquired Lymphangiectases and Breast Cancer. Actas Dermo-Sifiliográficas (English Edition). 2007;98(5):347-350. DOI:10.1016/S1578-2190(07)70459-6 2. Verzì AE, Lacarrubba F, Tedeschi A, Micali G. Localized acquired lymphangiectasias after breast surgery: Enhanced non-invasive diagnosis using dermoscopy and reflectance confocal microscopy. Skin Res Technol. 2020;26(2):205-208. DOI:10.1111/srt.12780. PMID: 31549745