Multiple Vesicles and Bullae on the Scrotum

Lymphangiomas can be classified into three main types: cavernous, circumscriptum (capillary), and cystic.1 Lymphangioma circumscriptum, the most common type, is the benign dilatation and malformation of inner lymphatic channels located in the deep dermal and subcutaneous tissues.1,2 The disease often affects the proximal portions of the extremities, but scrotal, vulvar, and mucosal lesions are rare. Patients often report bleeding after sexual intercourse or excoriation of the lesions.4 Idiopathic scrotal calcinosis is a rare, benign condition that causes hard, yellowish nodules. Histopathology shows well-encapsulated cysts with cyst walls.7 Summary Table Condition Characteristics Angiokeratomas of Fordyce Red or blue papules; bleeding after sexual intercourse or excoriation of the lesions; associated with severe varicosity or varicocele Idiopathic scrotal calcinosis Hard, yellowish dermal nodules consisting of calcium deposits under a normal epidermis; usually asymptomatic, but may itch or produce discharge Leukemia cutis Papules, but mostly nodules; accompanied by hepatosplenomegaly or a high serum leukocyte count; histopathology shows diffuse, band-like or nodular infiltration of leukemic cells Lymphangioma circumscriptum Thin-walled vesicles and bullae filled with translucent lymphatic fluid; histopathology shows numerous cystic lymphatic spaces lined with a flattened endothelium in the dermis Steatocystoma multiplex Multiple dermal cysts that are localized or widespread; asymptomatic or inflammatory; histopathology shows well-encapsulated cysts with cyst walls Address correspondence to Engin Senel, MD, at enginsenel@enginsenel.com.