title: Lymphangiectases are common underlying warts and in normal peritumoral skin: histologic evidence of decreased immune surveillance.
abstract: BACKGROUND
  Lymphangiectases are a histologic sign of lymphostasis, which is associated with decreased immune cell trafficking and cell-mediated immunity.
  
  
  OBJECTIVE
  To determine if latent lymphedema is apparent underlying warts and in skin affected by cutaneous neoplasia.
  
  
  METHODS
  The number and maximal dilation of lymphangiectases were measured in the upper half of the dermis of 51 consecutive biopsies of warts, 230 consecutive normal skin samples from primary skin tumor excisions, and 14 normal skin samples from breast reduction (11) and panniculectomy (3) specimens.
  
  
  RESULTS
  All warts had one or more underlying lymphangiectases compared with 79% of peritumor normal skin samples and 50% of cosmetic specimens. The mean number of lymphangiectases and mean maximal dilation were significantly greater in warts than in peritumor skin, which was significantly greater than cosmetic skin samples (3.6 vs. 1.3 vs. 0.12 lymphangiectases per square millimeter and 54 vs. 23 vs. 1 μm, respectively; P = 0.0001). Warts exhibited mild fibrosis significantly more frequently than peritumor skin (57% vs. 5%; P = 0.0001). For peritumor (normal) skin, age, solar elastosis, and adjacent malignancy correlated with greater dilation of lymphatics. Solar elastosis also correlated with increased number of lymphangiectases.
  
  
  CONCLUSIONS
  Minor trauma and solar elastosis from chronic ultraviolet radiation exposure are likely the etiologic factors in the development of lymphostasis. By decreasing immune surveillance, latent lymphedema ostensibly facilitates human papillomavirus infection and carcinogenesis.
authors.affiliation: Divisions of Dermatopathology and Dermatology, Department of Pathology, Albany Medical Center, Albany, NY 12208, USA.
authors.forename: Joan
authors.initials: J
authors.lastname: Paul
authors.forename: J Andrew
authors.initials: JA
authors.lastname: Carlson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007157:Immunologic Surveillance / Q000276:immunology*; D008200:Lymphangiectasis / Q000276:immunology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015595:Skin Aging / Q000276:immunology / Q000473:pathology; D012871:Skin Diseases / Q000276:immunology* / Q000473:pathology*; D012878:Skin Neoplasms / Q000473:pathology; D014860:Warts / Q000276:immunology* / Q000473:pathology*; D055815:Young Adult