Derm Dx: Traumatized erythematous papule above the eyebrow - Clinical Advisor

Derm Dx: Traumatized erythematous papule above the eyebrow

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A man, aged 45 years, presents with a lesion above his right eyebrow that was recently traumatized. The growth had been present for approximately 6 months and was asymptomatic. He is a 1-pack-per-day smoker. He drinks alcohol in moderation. The patient denies a history of systemic disease or family history of colonic polyps. Examination reveals a slightly erythematous 0.4-cm papule with a superficial hemorrhagic surface. No similar lesions were noted elsewhere.

A shave biopsy was performed, and histopathology revealed a traumatized sebaceous adenoma. Sebaceous glands are found in hair-bearing skin with the highest concentrations present on the face. Sebaceous adenomas are one of a number of neoplasms that arise from sebaceous glands,...

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A shave biopsy was performed, and histopathology revealed a traumatized sebaceous adenoma. Sebaceous glands are found in hair-bearing skin with the highest concentrations present on the face. Sebaceous adenomas are one of a number of neoplasms that arise from sebaceous glands, the most common being sebaceous hyperplasia. Sebaceous hyperplasia manifests as a yellowish papule with a central dell. In contrast, sebaceous adenomas are rarely encountered and presents as a well-circumscribed, pink-to-flesh-colored papule that may ulcerate or bleed.

Sebaceous adenomas have no malignant potential, but this neoplasm has been linked to visceral tumors, an association made by Muir and Torre independently from each other nearly a half century ago.1,2 Muir-Torre Syndrome (MTS) is an uncommon autosomal dominant genodermatosis with a high degree of penetrance and variable expressivity. The condition is now considered a subset of hereditary nonpolyposis colorectal cancer or Lynch syndrome.3 MTS occurs with a slightly higher prevalence in males, and patients have ranged in age from the third to ninth decade at diagnosis.

Sebaceous neoplasms may precede the onset of visceral malignancy by decades. Patients with or without a family history of gastrointestinal cancer who present with more than one lesion warrant screening.4 Abnormalities specific for MTS can be detected by genetic testing on peripheral blood or immunohistochemical analysis of a biopsy specimen.5

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. Muir EG, Bell AJ, Barlow KA. Multiple primary carcinomata of the colon, duodenum, and larynx associated with kerato-acanthomata of the face. Br J Surg. 1967;54(3):191-195.
  2. Torre D. Multiple sebaceous tumors. Arch Dermatol. 1968;98(5):549-551.
  3. Lynch HT, Lynch PM, Lanspa SJ, Snyder CL, Lynch JF, Boland CR. Review of the Lynch syndrome: history, molecular genetics, screening, differential diagnosis, and medicolegal ramifications. Clin Genet. 2009;76(1):1-18.
  4. Schwartz RA and Torre DP. The Muir-Torre syndrome: a 25-year retrospect. J Am Acad Dermatol. 1995;33(1):90-104.
  5. Eisen DB, Michael DJ. Sebaceous lesions and their associated syndromes: part II. J Am Acad Dermatol. 2009;61(4):563-578. 
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