Ask Dr. Peter Mortimer

Areas of Expertise:
  • Breast cancer related lymphoedema
  • Genetic basis of primary lymphoedema
  • Lymphatic spread of cancer eg melanoma

Professor Peter Mortimer trained in Dermatology in Sheffield and Oxford. He was appointed 'Physician to the Skin Department' at St George's and consultant skin physician to the Royal Marsden Hospital since 1986 and has been Professor of Dermatological Medicine to the University of London since 2000. Interest in lymphatics began in Oxford where he undertook his thesis on 'the measurement of skin lymph flow'. Current research is focused on breast cancer related lymphoedema, the genetic basis of primary lymphoedema and lipoedema as well as melanoma spread by lymphatics. He has over 240 publications cited on PubMed. He has been Chief Investigator on research programme grants from The Wellcome Trust, British Heart Foundation and Cancer Research UK. His clinical practice deals almost entirely with chronic oedema, lymphoedema, lymphatic malformations, lymph-related disorders and lipoedema. He is a founder of both the Lymphoedema Support Network and British Lymphology Society and appointed the first Clinical Training Fellow in Lymphovascular Medicine in the UK.

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  1. Lymphedema with cellulitis
    Question (Carmen, ):
    • Since uterine cancer diagnosis and treatment 5 years ago, I have had recurring infections. For the past two years I have experienced rapid onset of cellulitis and lymphedema. I am concerned because the cellulitis comes on so quickly as does the swelling. My doctor has me on daily antibiotic but I do not feel any better. Do you have any suggestions? I am frustrated. Thank you.

    • Apr 2016

      As per Dr. Mortimer-

      “Recurrent infections are a common occurrence with lymphoedema.  It is also very common for the effects of the infection to develop rapidly.  Patients can feel fine one minute and within 15 minutes feel ill with chills and flu-like symptoms.  This is because of the effect lymphoedema has on immune cell trafficking and function within the swollen region.  Research has shown that it is not helpful to give antibiotics only when infections occur.  The infections need to be prevented and the recommendation is for prophylactic penicillin.  Advice for patients on this subject can be found at Consensus.pdf

  2. Keratosis
    Question (Ken, ):
    • My question regards the skin lesions that appear to be a hyperkeratosis that are commonly seen particularly in cases of lower extremity lymphedema. Are these keratoses similar histologically to actinic keratoses which may develop from overexposure to sunlight? Do they simply represent a hyperplasia of the keratinocytes or a metaplasia of the keratinocytes in which their cell structure undergo change.

    • Sep 2015

      The hyperkeratosis seen with lymphoedema reflects an increase in the horny layer (keratin) on the surface of the skin.  It is related to the increased thickening of the skin which is often called elephantiasis because it represents elephant skin.  The hyperkeratosis is different from a keratosis which is a benign tumour on the surface of the skin usually resulting from sun damage. 

      Therefore the hyperkeratosis seen with lymphoedema is simply an excessive production of mature keratin from normal keratinocytes.  A keratosis is related to a hyperplasia or dysplasia of the underlying keratinocytes which are the cells responsible for producing the keratin.

  3. Air travel
    Question (Dorthy, ):
    • Well I am planning a trip and it takes 24hours to get there. I had the lymph node taken out of one arm pit and bc and I have a compression sleeve and I can wear it just incase but what else should I do. Is there a big risk of my arm swelling. Is there something I should worry about in Thailand, should I take shots.

    • Jul 2015

      Patients with existing lymphoedema do find that it temporarily deteriorates during a flight.  However it should return to its former condition within 24 to 48 hours of arrival providing there are no complications eg infection.  For patients with existing lymphoedema the recommendations are to wear the compression garment, perform regular exercises during the flight, elevate the swollen area as much as is feasible and ensure no dehydration.  The problem with air travel is inactivity and the cabin pressure.  On arrival it is worth undertaking exercise to stimulate lymph drainage.

  4. psorisis & lymphodema
    Question (Anna, ):
    • Having psoriasis flare-ups on my elbow of my bad arm is challenging. The meds for it don't work for long. What advise do you have to keep the flaking & rawness at bay?

    • Mar 2015

      In general lymphoedema does not affect psoriasis and therefore one would treat the psoriasis in the normal way with ultraviolet light therapy as creams are not that effective. Psoriasis could be,in theory, worse on a limb affected by lymphedema because of the alteration to immune cell trafficking from the compromised lymph drainage. Therefore it makes sense to treat the swelling as well as one can and ensure no infection (as infection can exacerbate psoriasis)

  5. Lymphedema with Angioedema
    Question (Joseph, ):
    • 20 years ago was the first time the back of my head swelled up. It would get really swollen, hot and skin was very tight. It would spread all over the back and into the temple region between 4-12 seconds. After a week or two, it would drain down my neck and out my shoulders. This continued a couple times a year, every single year. Last June, the swelling got worse and reached my face, swelling one eye shut. It no longer drains, as the back of my head and both sides of my neck down by the collarbone have big squishy lumps. In August and continuing, both my armpits and down both sides of my body have swollen up and have stayed that way. My arms, fingers, legs, knees, ankles and toes also are a bit swollen. From what I was told by a doctor was that I have Primary Lymphedema with Angioedema. However, other doctors aren't sure because I don't fit in the "norm" of Lymphedema patients since it's affecting my entire body, literally from head to toe. I've seen so many doctors (ENT, Immunologist, Neurologist, Vascular Surgeon, Internalist) and have every single one of them stumped. Do you have any idea or opinion or thought as to what these conditions are that are happening to me? For some reason, the doctors are not coming to any kind of conclusion to my situation. I look forward to hearing your thoughts. Much Thanks, Joe

    • Feb 2015

      I am not convinced from your history that you do have lymphoedema with angioedema.  Angioedema manifests with bouts of swelling which settle within minutes or over a few hours.  It is thought to be allergic but no cause is usually found.  It is certainly inflammatory and will respond to oral steroids.  There are reports in the literature of recurrent angioedema giving rise to lymphoedema.  However under those circumstances the lymphoedema swelling is persistent and usually affects sites such as the skin around the eyes, mouth or ears.  I would agree that your circumstances do not fit in with the norm either for angioedema or lymphoedema and therefore it is difficult through an online response to advise.  My suggestion would be to see a lymphoedema physician if possible.