Benign Lymphangiomatous Papules or Plaques after Radiotherapy is the Correct Terminology.

Sir,

I read with interest the paper by Rao in your esteemed journal describing the development of acquired lymphangiectasias in an operated case of breast carcinoma who had received radiotherapy.[1] The author had diagnosed the case as acquired lymphangiectasia following surgery and radiotherapy of breast cancer. Keeping in toe with recent advances in these post-radiation therapy cutaneous changes, I would like to offer my comments in the back ground of this case.

Radiation therapy, even at low doses, can induce a wide spectrum of vascular skin proliferations from benign to frankly malignant pathologies, such as cutaneous angiosarcoma. Fineberg and Rosen noted some post-radiation vascular lesions that were atypical but not really malignant, calling the vascular proliferations to be benign “atypical vascular lesions.”[2] Later in a five cases series published by Diaz-Cascajo et al., it was confirmed these lesions to be benign and proposed the term “benign lymphangiomatous papules” (BLAP) after radiation therapy.[3] Post-radiation vascular changes seem to follow a spectrum with BLAP at one end and aggressive metastatic angiosarcoma at the other extreme. In the past, various terms have been assigned to this entity, including acquired (progressive) lymphangioma, lymphangioma circumscriptum, and benign lymphangioendothelioma.[45] Recently, Gengler et al. examined the clinicopathologic features of 56 vascular lesions of the skin that occurred after radiotherapy for breast carcinoma, all of which had a benign clinical course though they had few features of atypical histology also.[6]

To conclude, cutaneous vascular proliferations that develop within the field of prior radiotherapy include rare aggressive tumors, such as angiosarcomas, and also benign lymphangiomatous proliferations (BLAP/plaques). One should always bear in mind that irradiated patients are at risk for developing angiosarcoma and should be keenly followed up regularly.