INTRODUCTION Syringoma is a common adnexal tumor formed by well-differentiated ductal elements.

Immunohistochemistry shows the presence of eccrine enzymes and the pattern of cytokine expression suggests differentiation toward the uppermost part of the dermal duct. It is unclear if these lesions represent true adnexal neoplasms or a hyperplastic response to an inflammatory reaction. These lesions are mostly benign, asymptomatic and occur primarily in young females. A very rare malignant syringoma has been described on the eyelids, characterized by larger size, isolated nature, and subcutaneous and perineural invasion.

CLINICAL PRESENTATION The lesions typically occur at the time of puberty and present as multiple small (1-3 mm), skin-colored to yellowish papules with a rounded or flat surface. They can sometimes appear translucent or cystic. Lesions are usually multiple and distributed symmetrically on the upper cheek and lower eyelids.

(Courtesy of Robert A. Goldberg, M.D.)

HISTOPATHOLOGY Syringomas are dermal tumors composed of small ductules usually lined by two layers of flattened cuboidal cells. An epithelial strand at the end of a ductule may create a tadpole or comma-like appearance. Solid nests and strands of epithelial cells are also present commonly. The lack of deep extension and perineural invasion differentiates syringoma from microcystic adnexal carcinoma.

DIFFERENTIAL DIAGNOSIS The differential diagnosis includes flat warts, milia, sarcoid nodules, trichoepithelioma, and basal cell carcinoma.

TREATMENT Syringomas are of cosmetic concern only. The most common forms of treatment include surgical excision, electrodessication, CO2 laser ablation, tricholoracetic acid, and cryotherapy. All forms of treatment carry a risk of scarring and the cosmetic result following removal may be less acceptable than the original condition.

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