Lymphatic malformations, previously known as lymphangiomas, are uncommon benign abnormalities of the lymphatic system that occur due to abnormal development of lymphatic vessels. These lesions may appear as clusters of translucent, reddish-purple, or skin-colored nodules and can occur anywhere on the body.
Patient Presentation
An elderly gentleman presented with a longstanding lesion in the preauricular region (area in front of the ear).
Over time, the lesion had progressively enlarged and was associated with:
- Recurrent episodes of spontaneous bleeding
- Occasional crusting and ulceration
- Cosmetic disfigurement
- Anxiety and discomfort due to repeated bleeding episodes
Clinical examination revealed multiple clustered vascular-appearing nodules with areas of hemorrhagic crusting, suggestive of a superficial lymphatic malformation, specifically a lymphangioma circumscriptum variant.
Understanding Lymphatic Malformations
Lymphatic malformations are congenital abnormalities of the lymphatic vessels. Although benign, they can become problematic when they:
- Bleed repeatedly
- Become infected
- Cause pain or irritation
- Interfere with daily activities
- Create cosmetic concerns
Many patients live with these lesions for years before seeking treatment, often because symptoms worsen gradually over time.
In this case, recurrent bleeding significantly affected the patient’s quality of life, making definitive treatment necessary.
Why Surgical Treatment Was Recommended
For symptomatic lymphatic malformations, treatment options may include:
- Observation
- Sclerotherapy
- Laser therapy
- Radiofrequency ablation
- Surgical excision
After detailed evaluation, complete surgical excision was considered the most appropriate treatment because the lesion was localized and causing repeated bleeding.
The primary goals were:
✔ Eliminate recurrent bleeding
✔ Remove the lesion completely
✔ Improve appearance
✔ Confirm the diagnosis through histopathology
✔ Reduce the risk of recurrence
Surgical Management
Complete Surgical Excision with Primary Closure
The procedure was performed by Dr. Girija H. R. under sedation and local anesthesia.
The lesion was carefully excised while preserving surrounding structures and maintaining normal facial contour.
Following complete removal, the wound was closed primarily, resulting in a fine linear scar with excellent cosmetic outcome.
Advantages of Surgical Excision
- Immediate removal of the problematic lesion
- Histopathological confirmation
- Single-stage treatment
- Reduced risk of future bleeding
- Excellent cosmetic result
- Long-term disease control
For localized lymphatic malformations, complete excision remains one of the most effective treatment options with lower recurrence rates when compared to incomplete removal.
Postoperative Outcome
The patient recovered smoothly without complications.
Results Achieved
✅ Complete removal of the lymphatic malformation
✅ No further bleeding episodes
✅ Excellent wound healing
✅ Minimal scarring
✅ Restoration of normal contour
✅ High patient satisfaction
The postoperative result demonstrated successful removal of the lesion while maintaining an aesthetically pleasing appearance.
Discussion
Lymphatic malformations can sometimes extend deeper than they appear on the surface, making treatment planning important.
Choosing the right treatment depends on:
- Lesion size
- Location
- Depth of involvement
- Symptoms
- Cosmetic considerations
For small, localized lesions associated with recurrent bleeding, surgical excision often provides the most definitive solution.
When performed by an experienced plastic surgeon, excision can achieve excellent functional and cosmetic outcomes while minimizing recurrence.
Conclusion
This case highlights the successful management of a recurrently bleeding lymphatic malformation in the preauricular region through complete surgical excision and primary closure under sedation.
The patient achieved complete symptom relief, excellent healing, and a highly satisfactory cosmetic outcome.
Early evaluation of persistent or recurrently bleeding skin lesions can help prevent complications and allow timely treatment.
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