Of the 59 pathways identified, 13 were felt to have a direct mechanistic link to the expression of lymphedema in the skin: antigen processing and presentation (p = 2×10−4); insulin signaling (p = 8×10−4); graft-versus-host disease (p<0.004); adherens junction (p = 0.007); apoptosis (p = 0.02); adipocytokine signaling (p = 0.02); VEGF signaling (p = 0.04); Wnt signaling (p<0.05); PPAR signaling (p<0.07); natural killer cell mediated cytotoxicity (P = 0.08); T cell receptor signaling (p<0.09) and hedgehog signaling (p<0.10). The gene discussed is INS; the disease is lymphedema.