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.
Prof. Mortimer, reading your posts for the first time on this site(LSN member UK, and secondary lymphoedema sufferer for 13 years). Interesting reading your take on surgery care for lymphoedema patients concerning tourniquets. Two years ago, I had a cardiac arrest at home(one of the lucky ones, I survived!) I was taken to the Freeman Hospital in Newcastle, and had an angioplasty and stent insertion. As we are "trained" to do, I mentioned that I had lymphoedema and therefore shouldn't have treatment on my affected right arm(crazy when my life was at stake, but you do this automatically). They said "don't worry, we can treat cellulitis if it happens!" I had an an incision in my right wrist, and the angioplasty followed. They then fitted an extremely tight plastic tourniquet to seal the artery. I watched it closely for 24 hours or there abouts, expecting problems. Next day, it was removed, and all was well. No effects whatsoever! Lucky or what?
Thank you for your enquiry
First of all I cannot criticise your doctors one bit as they quite rightly prioritised and your lymphedema came a distant second when it was a matter of life and death!
It is true to say that the risks of worse swelling or cellulitis following a sterile puncture are extremely small but if you happen to be the one who gets that complication then it is not acceptable.
As for tourniquets, again, there is a theoretical risk of worse swelling because of the sudden flush of blood and fluid into the arm when the tourniquet is released but as with a blood pressure cuff that risk is very small.
I would not describe you as lucky to have had a cardiac arrest but you would have been very unlucky to have suffered worse lymphedema
My dad who is 73, had shingles in July 2016. This resulted in neuropathic pains, which now has lasted a year. Nothing helps for pain relief, but what I am enquiring about is a swollen area filled with fluid under his armpit. It came after the shingles. Doctors in Holland are not sure what it is. He had physio for it, which has not reduced or changed it.It causes pain when he walks or moves. Also his skin remains extremely sensitive. Is he at risk for infection? Will the fluid stay or solidify? What is it? He never had this before. In your expertise, could you please advise me what this could be and which specialist should he refer himself to? He does take meds as he had a heart attack 3 years ago. He does not drink, eats healthy, cycles and walks. I live in the UK. He lives in Holland. Thank you.
Thank you for your enquiry
It is difficult to give a diagnosis without seeing and examining your father. Shingles does not cause a lymph problem. He needs an ultrasound examination or a CT to determine the nature of the swelling so that the correct treatment can be given.
The skin will remain sensitive because of the nerve damage from the shingles.
Your other questions are all dependent on the diagnosis.
If he is in Holland and his doctors think this is a lymph problem then I suggest he consults with Dr Robert Damstra in Groningen
Sorry not to be more help
Dr Mortimer I have developed lymphedema on both ankles at the age of 18. I am healthly and do not suffer from any other condition. Nobody in my family has this condition but I need to identify if It is primary or secondary Lymphedema as this increases the chances of giving birth to a child with the symptom. Is there any specific tests that determines if my condition is primary or secondary?
As per Dr. Mortimer-
A: This is likely to be primary lymphoedema (PL) because of the age of onset and because there has been no known damage to the lymph system. Many forms of PL are not inherited but the exact risk to offspring is dependent on the type of PL you have. This can only be determined through an expert who can characterise the type of primary lymphedema you have and if appropriate gene testing.
Hi. I am asking the question on behalf of a family member. As a result of being diagnosed with cancer of the uterus approx 14 years ago they underwent a full hysterectomy, they subsequently had chemotherapy and radiotherapy. The lymph nodes were removed from the left leg area. Over the past 4 years lymphodema has become an increasing problem down the left leg. A large lump has grown on the inner thigh and treatment is having very little impact. They are under the care of the Christie Hospital but due to this condition being extremely under funded there are very few options. They currently wear a compression stocking every day which is bearable however trying to obtain a second stocking has become impossible as the nurses never get the measurements right. Very frustrating!! They have visited a clinic in London to investigate the possiblity of lymph node transplant but apparently this is not an option as it has been stated there is a lot of scar tissue?? Whatever that means. I would like to know if there is anywhere in the UK that specialised in lymphodema and what does your research suggest for long term treatment? Many Thanks
As per Dr. Mortimer-
The large lump that has grown on the inner thigh is presumably a large lymphoedema fold although without imaging such as ultrasound examination one cannot be sure. Treating lymphoedema folds is difficult and needs very skilled bandaging. It is important to ensure there is no (over)weight issues as that makes these folds more likely to develop, and more difficult to treat. If all else fails one might have to consider liposuction but everything depends on the circumstances of this patient. Reconstructive lymphatic surgery is unlikely to be an option.
The biggest lymphoedema centre in the UK is at St George’s Hospital in London. The lymphoedema Support Network in the UK (http://www.lymphoedema.org/lsn) should be contacted for advice”
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.
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
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.
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.
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.
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.
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?
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)
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
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.
I am a left breast cancer survivor of 9 years. I had a lumpectomy and 3 sentinel nodes removed. I have also had a parathyroid removed ( benign) and have Hashimoto Thyroiditis. I want to undergo a trigger finger surgery on my left hand and am concerned about Lymphedema. The procedure involves a wound and a tourniquet on the arm/hand I have always been advised to protect from such things. Can you comment on the risk and any possible options to lessen the risk? Say if a tourniquet was somehow not used. Is the wound made and the tourniquet used the same level of risk? I don't want to trade a painful trigger finger for Lymphedema and I just don't know how to calculate the risk?
Thank you for this interesting question. You are right in saying that guidelines recommend avoidance of needle puncture/surgery/tourniquets in/on the at-risk arm following breast cancer treatment. The concern is that swelling could be precipitated. Furthermore there is always the risk of infection (cellulitis) which could also precipitate long-term swelling.
Therefore in an ideal world one would advise against trigger finger surgery but one has to do a risk/benefit analysis. If there is no alternative to your trigger finger then you should undergo surgery. However I would ask your surgeon if it can be done without tourniquet (assuming the tourniquet is around the upper arm or forearm). It may also be worthwhile covering the period around the surgery with antibiotics although there is no evidence that this is necessary.
I am afraid I don’t know the risk analysis of inducing lymphoedema but I would expect it to be very low with surgery alone and higher if the tourniquet is added.