Topical rapamycin and microcystic lymphatic malformations

We respectfully disagree with suppositions proposed in Cai et al’s1 editorial regarding García-Montero et al’s2 case series reporting the use of topical rapamycin for superficial lymphatic malformations. The first is the comment that “it is difficult to distinguish verrucous venous malformations from microcystic lymphatic malformations.” As García-Montero et al2 describe, microcystic lymphatic malformations present with “small translucent agminated vesicles” which may be associated with lymphorrhea.