title: Evidence for dermal angiogenesis in breast cancer related lymphedema demonstrated using dual-site fluorescence angiography.
abstract: OBJECTIVE
  To determine whether the skin expansion associated with breast cancer related lymphedema (BCRL) reduces microvessel density or causes a compensatory angiogenesis.
  
  
  METHODS
  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.
  
  
  RESULTS
  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)).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Physiological Medicine (Dermatology Unit), St. George's Hospital Medical School, London, UK. rmellor@sghms.ac.uk
authors.forename: R H
authors.initials: RH
authors.lastname: Mellor
authors.forename: A W B
authors.initials: AW
authors.lastname: Stanton
authors.forename: L
authors.initials: L
authors.lastname: Menadue
authors.forename: J R
authors.initials: JR
authors.lastname: Levick
authors.forename: P S
authors.initials: PS
authors.lastname: Mortimer
mesh_terms: D000368:Aged; D001132:Arm; D001794:Blood Pressure; D001808:Blood Vessels / Q000473:pathology; D001831:Body Temperature; D001943:Breast Neoplasms / Q000150:complications*; D004487:Edema / Q000209:etiology / Q000473:pathology; D005260:Female; D019793:Fluorescein / Q000493:pharmacokinetics; D005451:Fluorescein Angiography; D005456:Fluorescent Dyes / Q000493:pharmacokinetics; D006801:Humans; D008209:Lymphedema / Q000150:complications*; D008833:Microcirculation; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000175:diagnosis / Q000209:etiology*; D012867:Skin / Q000098:blood supply*; D013997:Time Factors
chemical_list: D005456:Fluorescent Dyes; D019793:Fluorescein