Lymphoedema is becoming a common problem in elderly patients
who develop cancer in the groin or axillary nodes and have a node clearance.
This is likely to follow breast or melanoma surgery but also can occur after
sentinel lymph node examination. The lymphedema gives a heavy swollen limb that
interferes with walking or sport but also predisposes to infection such as
cellulitis and makes any subsequent skin cancer excisions on the limb very
difficult. However it is the chronic skin changes that are particularly troublesome.
The epidermis thickens and thick crusts of keratin and serum build up on the
surface. These can be removed with 4% Salicylic acid in sorbolene cream applied
nocte. The skin surface becomes hard and may crack, oozing lymph fluid.
Sometimes the fluid pressure raises pseudo blisters in the skin. If the skin is
oozing with a secondary stasis dermatitis then a topical steroid cream such as
0.02% betamethasone with some mupirocin cream should be used twice daily. Once
the eczema is controlled efforts should be made to try to reduce the lymphedema
by compression bandaging or the process will just relentlessly progress. The
immobility caused by the lymphedema leads to obesity which just compounds the
problem. The best approach is to treat the condition early with massage and
compression bandaging to prevent these later changes occuring . The mossy leg
syndrome is an extreme example of the skin changes of chronic lymphedema where
the name accurately describes the surface appearance of the skin!
