Derm Dx: A nodule on the scalp since childhood - Clinical Advisor

Derm Dx: A nodule on the scalp since childhood

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A 39-year-old woman requests removal of a growth on her scalp. She was born in Nigeria and emigrated to the United States at the age of 26 years. She first noticed the lesion at age 10 years, at which time it was diagnosed as a wart. Since then, the lesion has enlarged slowly but has remained asymptomatic. Examination reveals a 2.0-cm firm, hyperkeratotic nodule on her mid scalp. No similar lesions are noted elsewhere. 

Syringocystadenoma papilliferum is a rare benign neoplasm that most commonly occurs on the scalp.1 The tumor is usually asymptomatic, although localized pain has been reported.2 The growth may be present at birth or may arise during childhood as a papule...

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Syringocystadenoma papilliferum is a rare benign neoplasm that most commonly occurs on the scalp.1 The tumor is usually asymptomatic, although localized pain has been reported.2 The growth may be present at birth or may arise during childhood as a papule that resembles a wart. In approximately one-third of cases, the lesion is associated with an underlying organoid nevus, nevus sebaceous.3 Syringocystadenoma papilliferum is believed to result from aberrant differentiation of the apocrine gland.4

 

Excision is curative. When borders are ill-defined, Mohs micrographic surgery may be beneficial.5 For anatomic areas that are not amenable to excision and grafting, use of the carbon dioxide laser has resulted in a favorable outcome.6

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. Helwig EB, Hackney VC. Syringadenoma papilliferum; lesions with and without naevus sebaceous and basal cell carcinoma. AMA Arch Derm. 1955;71(3):361-372.
  2. Mammino JJ, Vidmar DA. Syringocystadenoma papilliferum: report of an unusual case. Int J Dermatol. 1991;30(11):828.
  3. Cribier B, Scrivener Y, Grosshans E. Tumors arising in nevus sebaceus: a study of 596 cases. J Am Acad Dermatol. 2000;42(2 Pt 1):263-268.
  4. Vazmitel M, Michal M, Mukensnabl P, Kazakov DV. Syringocystadenoma papilliferum with sebaceous differentiation in an intradermal tubular apocrine component. Report of a case. Am J Dermatopathol. 2008;30(1):51-53.
  5. Chi CC, Tsai RY, Wang SH. Syringocystadenocarcinoma papilliferum: successfully treated with Mohs micrographic surgery. Dermatol Surg. 2004;30(3):468-471.
  6. Jordan JA, Brown OE, Biavati MJ, Manning SC. Congenital syringocystadenoma papilliferum of the ear and neck treated with the CO2 laser. Int J Pediatr Otorhinolaryngol. 1996;38(1):81-87.
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