Clinical Challenge: Cystic Papule Near Left Eye

Apocrine hidrocystoma, also known as an apocrine cystadenoma, is a benign cystic tumor that arises from apocrine sweat glands. The growth affects individuals aged 30 and 70 years.1It classically presents as an asymptomatic cystic nodule with color ranging from flesh...

Submit your diagnosis to see full explanation.

Apocrine hidrocystoma, also known as an apocrine cystadenoma, is a benign cystic tumor that arises from apocrine sweat glands. The growth affects individuals aged 30 and 70 years.¹

It classically presents as an asymptomatic cystic nodule with color ranging from flesh tone to blue. The most frequent location is the head and neck with the periorbital area being the most common.^1-4 Cases involving the chest, shoulders, and feet have been reported.³ The lesions appear as semi-translucent cysts with a diameter usually <1.0cm.

Multiple apocrine hidrocystomas are uncommon and may be associated with distinct genetic syndromes such as Goltz-Gorlin and Schopf-Schulz Passarge.² Goltz-Gorlin syndrome is an x-linked dominant condition that causes microcephaly, midfacial hypoplasia, malformed ears, papillomas of the lip, skeletal abnormalities, and mental retardation.⁵ Schopf-Schulz-Passarge is an autosomal recessive syndrome presenting with multiple eyelid apocrine hidrocystomas, palmoplantar hyperkeratosis, hypodontia, and hypotrichosis.⁶

Diagnosis of an apocrine hidrocystoma is usually based on the distinctive clinical appearance. Histologic examination will reveal a cystic lesion located in the dermis characterized by a single or multiple inner layers of secretory columnar cells and an outer myoepithelial layer.⁴

Apocrine hidrocystomas are simply managed with needle puncture and drainage. The cyst wall may be cauterized to prevent recurrence or vaporized utilizing a laser.^8,9

The differential diagnosis for an apocrine hidrocystoma includes an eccrine hidrocystoma, epidermal inclusion cyst, mucoid cyst, hemangioma, and lymphangioma. It can uncommonly resemble more serious conditions such as cystic basal cell carcinoma and, when dark blue, even malignant melanoma.²

Megha D. Patel, is a student at the Commonwealth Medical College, Scranton, Pennsylvania.

Stephen Schleicher, MD, is an associate professor of Medicine at the Commonwealth Medical College and an Adjunct Assistant Professor of Dermatology at the University of Pennsylvania Medical College. He practices dermatology in Hazleton, Pennsylvania.’

References

1. Smith JD, Chernosky ME. Arch Dermatol. 1974 May;109(5):700-2.
2. Sarabi K, Khachemoune A. MedGenMed. 2006; 8(3):57.
3. Kikuchi K, Fukunaga S, Inoue H, Miyazaki Y, Ide F, Kusama K. Head and Neck Pathol. 2014; doi: 10.1007/s12105-013-0451-2
4. Alessi E, Gianotti R, Coggi A. British Journal of Dermatology. 1997; 137:642-645.
5. Ascherman JA, Knowles SL, Troutman KC. Cleft Palate Craniofac J. 2002;39:469-473. Gira AK, Robertson D, Swerlick RA. Arch Dermatol. 2004;140:231-236.
6. Elder D. Tumors of Epidermal Appendages. (8th ed). Lipponcott; 1997;769-770.Alfadley A, Al Aboud K, Tulba A, Mazen M. Int J Dermatol. 2001;40:125-129.
7. del Pozo J, García-Silva J, Peña-Penabad C, Fonseca E. 2001 Jun;12(2):97-100.