Lymphangioma is a rare vascular malformation, comprising about 4% of such anomalies. Its most common symptom is swelling, which often leads to cosmetic deformity. The most prevalent subtype, lymphangioma circumscriptum, seldom presents on the vulvar area, making treatment especially challenging due to potential complications and recurrence risks.

This is a case of a 10-year-old Filipino female, otherwise healthy, who presented with progressively enlarging, tender, “frog spawn”-like papules on the left vulva since birth. These papules showed partial improvement following surgical excision. Histopathological examination confirmed the diagnosis of lymphangioma. Over the past year, the patient experienced recurrence of papules, resulting in vulvar asymmetry and labial swelling. Pelvic magnetic resonance imaging (MRI), ultrasound, and fine needle aspiration biopsy, revealed multiple superficial and deep cystic masses consistent with lymphangioma. Long-pulsed Nd:YAG laser was administered to the external lesions, yielding partial improvement. Subsequently, she underwent ultrasound-guided sclerotherapy with bleomycin under local anesthesia.

This procedure, performed by interventional radiology, successfully resolved the deep cysts and swelling after two sessions, with no reported complications.

In cases of cutaneous lymphangioma, especially in anatomically sensitive regions like the vulva, imaging plays a crucial role in determining lesion depth and guiding treatment to minimize recurrences. Although no local literature is available, this case highlights the effectiveness and safety of ultrasound-guided sclerotherapy with bleomycin as a novel treatment option for lymphangioma.