DEAR EDITOR, Massive localized lymphoedema (MLL) is a rare entity associated with morbid obesity. A 59-year-old woman with a body mass index of 57 2 kg m 2 presented for evaluation of a 2-year growing mass on her left thigh (a). Computerized tomography of the mass revealed diffuse oedema in the subcutaneous tissues (b). Biopsy demonstrated superficial and deep perivascular dermatitis (c). D2-40 immunostaining highlighted dilated lymphatic spaces (d). Taken together, the findings were consistent with MLL. After careful preoperative work-up, the mass was surgically excised. The final pathology report was consistent with a diagnosis of MLL.