Derm Dx: A recurring firm and hyperpigmented nodule - Clinical Advisor

Derm Dx: A recurring firm and hyperpigmented nodule

Slideshow

  • Slide

A 45-year-old woman who is moderately obese presents with a recurrent lesion on her left leg. The lesion was removed elsewhere by shave excision but re-formed after several months. She was advised that the biopsy was benign. Trauma to the site has resulted in bleeding, but otherwise the lesion has been asymptomatic. The patient has a history of mild hypertension. Examination of her left leg reveals a 0.5-cm hyperpigmented papule. Inguinal nodes are nonpalpable.

A diagnosis of clear cell hidradenoma was made based on histology. Clear cell hidradenoma, which are also called eccrine acrospiroma, are benign, slow-growing tumors that are derived from eccrine or apocrine sweat glands.1 These neoplasms most commonly occur in the...

Submit your diagnosis to see full explanation.

A diagnosis of clear cell hidradenoma was made based on histology. Clear cell hidradenoma, which are also called eccrine acrospiroma, are benign, slow-growing tumors that are derived from eccrine or apocrine sweat glands.1 These neoplasms most commonly occur in the sixth decade of life, although clear cell hidradenoma have been reported in individuals ranging from children to elderly persons.1-3 Females are affected more commonly than males.1,2

A clear cell hidradenoma presents as an asymptomatic, skin-colored or red, firm nodule that grows slowly. The tumors can arise anywhere on the body, but they occur more commonly on the scalp, face, thorax, and abdomen.2,4 The lesions may appear vascular, similar to pyogenic granuloma. The differential diagnosis also includes hemangioma, glomus tumor, nodular melanoma, dermatofibrosarcoma, and trichilemmoma.2


Definitive diagnosis of clear cell hidradenoma is accomplished by biopsy of the lesion. Histopathology reveals an unencapsulated and circumscribed tumor in the mid or upper dermis that may extend into the subcutaneous fat. The tumor has 2 types of cells: round, fusiform, or polygonal cells with vesicular nuclei and cells with clear cytoplasm and basophilic nuclei.1

Treatment of clear cell hidradenoma is accomplished by excision with full margins. Malignant transformation, although rare, has been reported, and incompletely excised lesions are prone to recurrence.1,5

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

Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He practices dermatology in Hazleton, Pennsylvania.

References

  1. Egesi A, Ingraffea A. What is your diagnosis? Clear cell hidradenoma. Cutis. 2014;94(6):268, 271-272.
  2. Gonul M, Cakmak SK, Gul U, Han O, Karagece U. A skin tumor in a young girl. Diagnosis: clear cell hidradenoma. Indian J Dermatol Venereol Leprol. 2010;76(4):445-446.
  3. Faulhaber D, Wörle B, Trautner B, Sander CA. Clear cell hidradenoma in a young girl. J Am Acad Dermatol. 2000;42(4):693-695.
  4. Yaghoobi R, Kheradmand K. Clear cell hidradenoma in a young boy. Indian J Dermatol Venereol Leprol. 2007;73(5):358-359.
  5. Ozawa T, Fujiwara M, Nose K, Muraoka M. Clear-cell hidradenoma of the forearm in a young boy. Pediatr Dermatol. 2005;22(5):450-452.
Next hm-slideshow in Clinical Quiz