Evidence for dermal angiogenesis in breast cancer related lymphedema demonstrated using dual-site fluorescence angiography

To determine whether the skin expansion associated with breast cancer related lymphedema (BCRL) reduces microvessel density or causes a compensatory angiogenesis. Dermal microvessel density was measured by simultaneous fluorescence video angiography in the ipsilateral and contralateral forearms of 25 patients treated for breast cancer, 12 with BCRL (excess volume 30 +/- 20%) and 13 without. Microvessel density was as high in the swollen arm (27.2 +/- 7.2 mm(-2)) as in the contralateral arm (24.2 +/- 6.2 mm(-2)) despite a 16 +/- 12% increase in local circumference. Total microvessels in a 1-mm annulus of skin was 30% greater in the swollen arm (752 +/- 211) than the contralateral arm (578 +/- 157; p = 0.005, t-test). Microvessel density was similar in each arm in control patients (ipsilateral 24.1 +/- 6.2 mm(-2), contralateral 26.1 +/- 8.8 mm(-2)). The number of microvessels increased in the expanded skin to maintain microvessel density at a normal level. Therefore, angiogenesis occurs during chronic limb swelling. The control group results indicate that angiogenesis is not caused by the cancer treatment.