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Superficial lymphangioma treated with fractional ablative laser: a case report with clinical and reflectance confocal microscopy evaluation.

Lymphangiomas are benign vascular malformations caused by the dilation of lymphatic vessels. Superficial lymphangiomas are characterized by multiple clustered asymptomatic vesicles ranging from 2 to 5 mm in diameter. The vesicles usually contain a clear liquid, but they can become pink to purple when small hemorrhages occur. These vesicles represent superficial saccular dilations from the underlying lymphatic vessels. Those dilated lymphatic vessels are mostly located in the papillary dermis, but they can extend into the dermis and the hypodermis. Superficial lymphangiomas are difficult to treat. They have a high recurrence rate because of their deep component. Surgery is the treatment of choice, but the potential for recurrence exists, and the results are not always cosmetically acceptable. Other treatment modalities such as sclerotherapy, radiofrequency, carbon dioxide laser, and pulsed dye laser have been proposed, but none of these approaches gives truly satisfactory results. We report a case of superficial lymphangioma treated using a fractional ablative laser assessed using clinical and reflectance confocal microscopy (RCM) evaluation with long-term follow-up.