C. Axillary web syndrome
Associated with the clinical findings, a subtle cord that projected from the largest nodule to the axillary region could be seen in physical examination (Figure, A). An excisional biopsy of the larger lesion showed the presence of dilated and thrombosed vessels in the subcutaneous tissue, with signs of recanalization. Other features present were edema, areas of acute hemorrhage, recent fibrosis, and focal steatonecrosis, without evidence of malignant melanoma (Figure, B). An immunohistochemical study confirmed the lymphatic vascular origin of the lesion, with expression for CD31, ERG and D2-40 (podoplanin) antibodies. Human herpesvirus 8 test results were negative. In this setting, a Sox10 staining was also performed, ruling out a metastasis of melanoma. The medical history of a left axillary SLNB associated with the clinical, pathological, and special staining findings confirmed the diagnosis of axillary web syndrome (AWS).