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Epidermal Nevi, Neoplasms, and Cysts Part III Chapter 29 Michael Hohnadel 8/2005

Epidermal Nevi, Neoplasms, and Cysts Part III Chapter 29 Michael Hohnadel 8/2005. Small translucent papule Commonly on eyelids or upper cheeks. Also may occur on: Axilla, abdomen, forehead, penis, vulva. Develop slowly and persist indefinitely 18% of adults with Down’s syndrome

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Epidermal Nevi, Neoplasms, and Cysts Part III Chapter 29 Michael Hohnadel 8/2005

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  1. Epidermal Nevi, Neoplasms, and Cysts Part IIIChapter 29Michael Hohnadel 8/2005

  2. Small translucent papule Commonly on eyelids or upper cheeks. Also may occur on: Axilla, abdomen, forehead, penis, vulva. Develop slowly and persist indefinitely 18% of adults with Down’s syndrome Dilated cystic sweat ducts. Clear cell variant assoc with DM. Treatment: Electrodessication, Laser ablation cryotherapy. Syringoma

  3. Syringoma Dilated sweat ducts with tadpole appearance.

  4. Numerous lesions on the neck, chest, axilla, upper arms and periumbilically. May resemble LP or 2nd Syphilis as well as reticulated papillomatosis of Gougerot-Carteaud. Young persons. Histologically identical to solitary. Reported in Down’s syndrome Clinically may be confused with reticulated papillomatosis of Gougerot-Carteaud Eruptive syringoma

  5. Translucent papules 1-3mm which may have a bluish tint. Occur on the face. Usually solitary, however, multiple lesions may be seen May become more prominent in hot weather. Treatment – excision Topical atropine or scopolamine Eccrine hidrocystomas

  6. Eccrine hidrocystomas Cyst cavity lined by double of of cuboidal cells.

  7. Eccrine poroma • Benign, slow-growing, slightly protruding, sessile, soft, reddish tumor • Most commonly occur on the sole or the side of the foot. May occur anywhere. • Bleeds with slight trauma • Frequent cup-shaped shallow depression from which the tumor grows • Benign – simple excision • Eccrine poromatosis

  8. Eccrine poroma

  9. Eccrine poroma Eccrine poroma, scan power view. Note numerous epidermal connections by the tumor and the degree of acanthosis.

  10. Eccrine poroma Low power view of above showing the vascular stroma and relatively uniform cell population.

  11. Eccrine poroma High power view of the small kertinocyte population having distinct cytoplasmic borders.

  12. Most arise from longstanding eccrine poromas (50%) Clinically similar May also manifest as a blue or black nodule, plaque or ulcerated tumor M=F, avg 70 yrs. Distribution: Legs 30%, feet 20%, face 12%, thighs 8% If metastatic, 70% mortality Mohs is TOC Malignant eccrine poroma(porocarcinoma)

  13. Malignant eccrine poroma There are sharply demarcated nests of tumor within the epidermis. There is rim of normal epidermal keratinocytes in most areas

  14. Malignant eccrine poroma Atypia is prominent. There are no transitional atypical cells blending with the peripheral normal keratinocytes.

  15. Chondroid Syringoma Firm intradermal or subcutaneous nodule, most commonly located on the nose or cheeks 80 % involving the head and neck Felt to be of eccrine origin Malig. Chon. Syringoma Malignant mixed tumor of the skin Most occur on extremities. Reported on face, scalp, back, buttocks Grow rapidly. Metastasis more the 50% Aggressive surgical excision, Adjuvant radiation therapy w/wo chemotherapy Chondroid Syringoma and Malignant Chondroid Syringoma

  16. Chondroid Syringoma

  17. Chondroid Syringoma (mixed tumor of the skin) Scanning power view of a sharply demarcated subcutaneous tumor. There are tubular foci, a cystic area and a solid component.

  18. Chondroid Syringoma A medium power view showing tubular differentiation.

  19. Classified as an eccrine sweat gland tumor Flesh colored or reddish, nodular protruding mass. May be solid or cystic. Location: Anywhere. Most common site is the head 20% c/o pain on pressure Multiple lesions reported Women 2x > men Extirpation is TOC Clear cell hidradenoma(nodular hidradenoma)

  20. Clear cell hidradenoma(nodular hidradenoma)

  21. Clear cell hidradenoma(nodular hidradenoma) Scan power view. Note: epidermal connections are not usually present. Circumscribed nodular architecture.

  22. Clear cell hidradenoma(nodular hidradenoma) High power view. The luminal cells have some apocrine features. Some of the epithelial cells have clear cytoplasm (glycogen) and some do not.

  23. Clear cell hidradenoma(nodular hidradenoma) Arrows point to some of the mucus producing cells.

  24. Malignant clear cell hidradenoma(hidradenocarcinoma) • Extremely rare • Presents as a solitary nodule • Lower extremity 32.9 %, upper extremity 27.6 %, trunk 11.9 %, head 26.3 % • Metastasis occurs 60% • Tx wide local excision, radiation and chemotherapy

  25. Solitary, 1cm, deep-seated nodule. Most frequently seen on the ventral surface. Skin-colored, blue or pink with normal overlying skin. Paroxysmal pain Especially upper half of the body Multiple lesions, linear pattern may be seen Eccrine spiradenoma

  26. Benign clinical course TX: Simple excision DDX may include: A - angiolipoma N - neuroma G - glomus tumor E L – leiomyoma Eccrine spiradenoma

  27. Eccrine spiradenoma Spiradenoma composed intertwining cords of light and dark cells having no visible cytoplasmic junctions.

  28. Malignant eccrine spiradenoma • In long standing lesions malignant degeneration may occur and my be lethal. Malignant Eccrine Spiradenoma

  29. Papillary eccrine adenoma • Uncommon benign lesion. • Dermal nodules, most common on extremities of black patients. • Tendency to recur. • Treatment: Complete surgical excision

  30. Papillary eccrine adenoma Note the papillary intraluminal projections These and the long tubules help to differentiate this from a syringoma..

  31. Most presentations are a solitary, hyperkeratotic nodule or plaque involving the extremities Characteristic marker of Schopf syndrome Hydrocystomas of the eyelids, hypotrichosis, hypodontia, and nail abnormalities Eccrine syringofibroadenoma

  32. Other names: Dermal eccrine cylindroma, Spiegler’s tumor, turban tumor, and tomato tumor. Pinkish to blue, solitary (usually), firm rubbery nodule on scalp or face. Women chiefly affected Slow growing. Rarely undergo malignant degeneration Treatment :excision cylindroma

  33. Dominantly inherited form: Numerous rounded masses of various sizes on the scalp Appears soon after puberty Resembles bunches of grapes or small tomatoes cylindroma

  34. cylindroma • Well fit jigsaw pattern. • Round aggregates of eosinophilic material (arrow)

  35. Eccrine carcinoma No characteristic clinical appearance High incidence of metastatic spread Mucinous eccrine carcinoma Commonly a round, elevated, reddish, and sometimes ulcerated mass Usually head and neck (75%) Slow growth, asymptomatic 11% incidence of metastasis Local excision Sweat gland carcinoma

  36. Aggressive digital papillary adenocarcinoma • Aggressive malignancy involving the digit between the nail bed and the distal interphalangeal joint spaces in most cases. • Presents as a solitary nodule • 50% recurrence rate. 50% metastasis. • All patients should have CXR • Complete excision TOC • Amputation may be required.

  37. Microcystic Adnexal Carcinoma(sclerosing sweat duct carcinoma) • A very slow-growing plaque or nodule. Occurs most commonly on the upper lip of women. Central face. • Perineural infiltration is common and may be extensive • TOC Mohs. • No reports of metastases

  38. Microcystic adnexal carcinoma

  39. Microcystic adnexal carcinoma • Poorly circumscribed. • Ducts. • Tumor islands • *deeper than wide*

  40. APOCRINE GLANDS

  41. ceruminoma • Rare apoeccrine tumor that rarely becomes malignant • Firm nodular mass in the EAC • Ulceration and crusting may occur • Obstruction if large. • Questionable true entity • Treatment - excision

  42. Hidradenoma papilliferum • Benign solitary tumor • Almost exclusively on the vulva • Bleeding, ulceration, discharge, itching and pain • Firm nodule • excision

  43. Most commonly develops in a nevus sebaceous of Jadassohn Scalp or face Firm rose red papules in groups, with vesicle-like inclusions. May simulate MC Transition to carcinoma is rare Excision is advised Syringadenoma papilliferum(syringocystadenoma papilliferum)

  44. Syringoma papilliferum

  45. Syringoma papilliferum • Irreg. tubules lined by double cell layer with decapitation secretion. • Plasma cells in stroma

  46. Solitary, dome-shaped, smooth-surfaced translucent nodule. Bluish or brownish. Benign tumor Occurs chiefly on the face. Penile shaft- median raphe cyst. TX: Simple excision Apocrine hidrocystoma/cystadenoma(apocrine retention cyst)

  47. Apocrine hidrocystoma Large cystic spaces. Decapitation secretion

  48. Apocrine hidrocystoma A high power view of the linings of two of the cysts. A few brown,  lipofuchsin pigment granules (PG) are in the basilar part of the epithelium. Apocrine snouts are prominent.

  49. Apocrine gland carcinoma • Rare • Axilla is the most common site • May be seen in the nipple, vulva and EAC • May originate from aberrant mammary glands • Widespread metastases may occur

  50. HAIR FOLLICLE NEVI AND TUMORS

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