Clinical Challenge: Flesh-Colored Growth on the Cheek - MPR

Clinical Challenge: Flesh-Colored Growth on the Cheek

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A 75-year-old man presents for evaluation of a growth on his right cheek. He believes that the lesion has been present for at least 2 years and is occasionally traumatized by shaving but is otherwise asymptomatic. Examination reveals a flesh-colored papule with a central umbilication.

Sebaceous gland hyperplasia is a benign proliferation of the sebaceous glands.1 Patients with this condition may describe asymptomatic, yellow, shiny bumps on the forehead, cheeks, or near the hair line. Characteristically these lesions are dome-shaped papules with a central umbilication.2 Lesions can...

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Sebaceous gland hyperplasia is a benign proliferation of the sebaceous glands.1 Patients with this condition may describe asymptomatic, yellow, shiny bumps on the forehead, cheeks, or near the hair line. Characteristically these lesions are dome-shaped papules with a central umbilication.2 Lesions can occur throughout the integument but most commonly arise on areas of photodamage on the chest, upper neck, and face in middle-aged and elderly people.1 Several variants of sebaceous hyperplasia have been reported including familial form, giant form of 10 mm in diameter, and those in a linear arrangement.3 The underlying pathologic mechanism is unknown; however, lesion formation is associated with ultraviolet irradiation, advanced age, and immunosuppressive therapy. Treatment with cyclosporine alone or in combination with corticosteroids may induce lesion formation.3

Lesions typically appear as a pink-to-white firm papule ranging from 5 to 10mm in diameter with sharp demarcated borders. The surface of the papules appear smooth and shiny.3 Dermatoscopy may help differentiate sebaceous hyperplasia from other disorders such as molluscum contagiosum, sebaceous carcinoma, sebaceous adenoma, and basal cell carcinoma.1 Dermatoscopic examination reveals yellowish-white clods or lobules with linear vessels between or above the clods exhibiting a reticular distribution.3 Shave biopsy with histopathologic examination can rule out basal cell carcinoma and establish the diagnosis of sebaceous hyperplasia.2,3

Current therapies used for treatment include bichloroacetic acid, cryotherapy, shave excision, electrodessication, and laser ablation.1 In refractory cases, oral isotretinoin has been shown to be effective.4

References

  1. 1. Hogan D, Mohammad S. Sebaceous hyperplasiaExpert Rev Dermatol. 2011;6(1):91-96.
  2. 2. Higgins JC, Maher MH, Douglas, MS. Diagnosing common benign skin tumorsAm Fam Physician. 2015;92(7):601-607.
  3. 3. Sato T, Tanaka M. Linear sebaceous hyperplasia on the chestDermatol Pract Concept. 2014;4(1):93-95.
  4. 4. Yu C, Shahsavari M, Stevens G, Liskanich R, Horowitz D. Isotretinoin as monotherapy for sebaceous hyperplasiaJ Drugs Dermatol. 2010;9(6):699-701.