Dermatology: Practical and Conceptual Image Letter | Dermatol Pract Concept. 2025;15(2):5343 1 Cutaneous Lymphangioma Circumscriptum Xinxin Lei1, Ke Bian1, Bo Xie1 1 Hangzhou Third People’s Hospital, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China Citation: Lei X, Bian K, Xie B. Cutaneous Lymphangioma Circumscriptum. Dermatol Pract Concept. 2025;15(2):5343. DOI: https://doi.org/10.5826/dpc.1502a5343 Accepted: January 9, 2025; Published: April 2025 Copyright: ©2025 Lei et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: National Natural Science Foundation of China (82303998); Medical Science and Technology Project of Zhejiang Province (2023KY189) Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Bo Xie, Department of Dermatology, Hangzhou Third People’s Hospital, Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, West Lake Rd 38, Hangzhou, 310009, People’s Republic of China. ORCID ID: 0000-0001-9374- 863X. E-mail: wavethanks@zju.edu.cn Case Presentation A 27-year-old woman presented with translucent cutaneous vesicles that she had had for 10 years. A diagnosis of cutaneous lymphangioma circumscriptum (CLC) was made based on clin- ical findings (asymptomatic, ˂ 4 mm clusters of translucent pink and red vesicles on the right hip) (Figure 1A), histopathology (cystic lymphatic space lined with a flattened endothelium in the dermis) (Figure 1B), dermoscopy (light brown lacunas surrounded by pale septa, red lacunae, and hypopyon-like features) (Figure 1C), and gadolinium-DTPA-enhanced mag- netic resonance imaging (MRI) (a markedly increased signal intensity cystic lesion in the subcutaneous tissue of right hip, measuring 6.5×6.1×2.3 cm) (Figure 1D). Teaching points Lymphangiomas are congenital malformations of the lym- phatic system which may involve skin, subcutaneous tissue. Lymphangiomas, accounting for 4% of all vascular tumors, are uncommon. Clinically and pathologically, they are clas- sified as CLC, cavernous lymphangiomas, and cystic hy- gromas [1,2]. Gencoglan et al. defined new dermoscopic features for CLC: hypopyon-like features, a sign when the blood in the cavity accumulates in the lowest part of the lacunae due to gravity, which is similar to the accumulation of white blood cells in the exudate between the iris and cor- nea [1]. Classically, the given feature appears in our case. Dermoscopy can help distinguish between warts and mollus- cum contagiosum, which resemble smaller CLC. Therefore, using dermoscopy as an auxiliary tool in clinical practice is recommended. MRI, the preferred imaging, is crucial for determining the extent of CLC and is helpful in completing surgical resection [2]. 2 Image Letter | Dermatol Pract Concept. 2025;15(2):5343 References 1. Gencoglan G, Inanir I, Ermertcan AT. Hypopyon-like features: new dermoscopic criteria in the differential diagnosis of cutane- ous lymphangioma circumscriptum and haemangiomas? J Eur Acad Dermatol Venereol. 2012;26(8):1023-1025. DOI: 10.1111 /j.1468-3083.2011.04136.x. PMID: 21645121. 2. Patel GA, Schwartz RA. Cutaneous lymphangioma circumscriptum: frog spawn on the skin. Int J Dermatol. 2009;48(12):1290-1295. DOI: 10.1111/j.1365-4632.2009.04226.x. PMID: 19930489. Figure 1. (A) Asymptomatic, ˂4 mm clusters of translucent pink and red vesicles on the right hip. (B) Clustered cystic lymphatic spaces in the dermis and lined with a flattened endothelium (H&E, ×100). (C) Light brown lacunas surrounded by pale septa, red lacunae, and hypopyon-like features (green arrow). (D) A markedly increased signal intensity cystic lesion in the subcutaneous tissue of right hip, measuring 6.5×6.1×2.3 cm.