Aim A six-year-old child presents with clustered vesicles with underlying erythema on the right side of the neck (figure 1). Most vesicles contained clear fluid, but some contained hemorrhagic fluid. They initially presented as a small, raised lesion at birth, but the number of lesions gradually increased. Rubbing and scratching the lesions causes pruritus and irritation. No family history of similar skin abnormalities. Her past medical history was notable for a left-sided cholesteatoma.

Material and Method Ultrasound was unrevealing, and magnetic resonance imaging showed superficial T2 hyperintense non-enhancing cutaneous and subcutaneous lesions over the right lateral neck with minimal extension into the superficial right supraclavicular soft tissues.

Results Punch biopsy revealed anastomosing, fluid-filled pockets in the papillary and reticular dermal layers.

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Abstract PP-112 Figure 1

Clustered Vesicles on Neck. Grouped vesicles on the neck containing clear-to-hemorrhagic fluid with underlying erythema.

Conclusions Lymphatic malformation is a congenital vascular malformation composed of slow-flow lymphatic channels. Histopathology is necessary to differentiate microcystic lymphatic malformation from macrocystic lymphatic malformation, dermatitis herpetiformis, herpes zoster, and extragenital bullous lichen sclerosus. Clinicians should consider the depth and position of LM and any symptoms or complications such as pruritus, discomfort, bleeding, or secondary infections. Magnetic resonance imaging (MRI) has typically been considered the gold standard for determining the size and depth of a malformation. However, ultrasonography with Doppler flow may be considered an initial diagnostic and screening test, as it can distinguish between macrocystic and microcystic components and provide superior images of microcystic lesions, which are below the resolution capacity of MRI. Though our patient chose serial excision of her microcystic LM, there is no consensus on the best treatment for LM, and several methods have significant recurrence or complications. Excision, cryotherapy, radiation, sclerotherapy, and laser therapy are procedural options, while sildenafil - PDE5 inhibitor and sirolimus (oral or topical) mTOR - inhibitor are pharmacologic options. Patients may need repeat treatments or a combination of therapies due to recurrence.