Topical rapamycin in superficial lymphatic malformation: Microcystic lymphatic malformation or verrucous venous malformation?

To the Editor: We read the interesting study by Montero et al1 reporting the use of topical rapamycin in the treatment of superficial lymphatic malformation (LM). They concluded that topical rapamycin modifies the clinical appearance and alleviates the symptoms of superficial LM. Apart from the side effects and danger presented in the lethal cases treated by oral sirolimus, topical rapamycin treatment for superficial LM could be an effective and safer option. However, we are still concerned about the possibility of overlooking the effective response of microcystic LM to rapamycin and the existence of the potential verrucous venous malformation (VVM) component in this study.