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A 27-year-old woman presents for removal of a growth on her right cheek. The patient first noted the lesion approximately 18 months ago and it has been gradually increasing in size. She is in good health and takes no oral medications. She received therapy for acne as a teenager. The patient notes that this condition is starting to flare. Physical examination reveals a firm 1.5 cm whitish nodule with a hyperpigmented center. The lesion was punctured with an 11 blade and, after applying firm pressure to the base, a chalky substance was extruded.
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Biopsy of the lesion revealed a solitary steatocystoma. Solitary steatocystomas are associated with steatocystoma multiplex, which presents as multiple smooth flesh-colored to yellowish cysts arising on the trunk and less frequently the upper arms. Lesions first appear in adolescence or early adulthood.1 The majority of cases are sporadic although some are transmitted as an autosomal dominant inherited disorder involving a gene that codes for keratin.2
Solitary steatocystoma was first described in 1982.3 Also referred to as steatocystoma simplex, these rare lesions most often arise in middle-aged to elderly adults and may occur on the head, neck, trunk, and extremities.4 A case involving the eyelid of a 4-year-old child has been reported.5 Histology of a steatocystoma reveals a cystic structure containing sebaceous glands within the cyst wall. Simple excision is curative.
Alleigh Dunagan, NP-C, is a nurse practitioner on staff of the DermDox Dermatology Center in Mechanicsburg, Pennsylvania.
Stephen Schleicher, MD, is director of the DermDox Dermatology Centers, associate professor of medicine at Geisinger Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.
References
1. Varshney M, Aziz M, Maheshwari V, et al. Steatocystoma multiplex. BMJ Case Rep. 2011;2011:bcr0420114165. doi:10.1136/bcr.04.2011.4165
2. Oh SW, Kim MY, Lee JS, Kim SC. Keratin 17 mutation in pachyonychia congenita type 2 patient with early onset steatocystoma multiplex and Hutchinson-like tooth deformity. J Dermatol. 2006;33(3):161-164. doi:10.1111/j.1346-8138.2006.00037.x
3. Brownstein MH. Steatocystoma simplex. A solitary steatocystoma. Arch Dermatol. 1982;118:409-411.
4. Ishida Y, Takahashi Y, Takahashi E, Kitaguchi Y, Kakizaki H. Steatocystoma simplex of the lacrimal caruncle: a case report. BMC Ophthalmol. 2016;16(1):183. doi:10.1186/s12886-016-0358-2
5. Araujo KM, Denadai R. Clinical misdiagnosis of steatocystoma simplex of eyebrow in a pediatric patient. Chin Med J (Engl). 2016;129(3):377-378. doi:10.4103/0366-6999.174493
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