Ординатура / Офтальмология / Английские материалы / Diagnostic Atlas of Common Eyelid Diseases_Dutton, Gayre, Proia_2007‎

Sarcoidosis (Contd.)

DIFFERENTIAL DIAGNOSIS The differential diagnosis includes discoid lupus erythematosus, chalazia, hordeola, epidermal inclusion cyst, xanthelasma, lipoid proteinosis, amyloidosis, sebaceous cyst, lichen planus, erythema nodosum, tuberculosis, leprosy, syphilis and parasitic, fungal, viral (molluscum contagiosum, herpes simples and herpes zoster), or bacterial infections.

TREATMENT Diagnosis is supported by chest X-ray (positive in 80%), tuberculin skin test anergy, increased angiotensin-converting enzyme, positive gallium scan, elevated serum protein level with elevated alph-2globulin fraction, and elevated serum calcium level. Treatment revolves around systemic steroids. The most favorable prognosis is seen in younger patients with the more acute self-limited form of sarcoidosis. Associated intraocular inflammation is controlled with topical steroids and cycloplegics. Eyelid lesions often respond to systemic corticosteroid therapy, however, they often recur when treatment is stopped. Intralesional triamcinolone for cutaneous palpebral sarcoidosis can be effective for localized eyelid disease.

REFERENCES

Bersani TA, Nichols CW. Intralesional triamcinolone for cutaneous palpebral sarcoidosis. Am J Ophthalmol 1985; 99:561–562. Biswas J, Krishnakumar S, Raghavendran R, Mahesh L. Lid swelling and diplopia as presenting features of orbital sarcoid.

Indian J Ophthalmol 2000; 48:231–233.

Browstein S, Liszauer AD, Carey WD, Nicolle DA. Sarcoidosis of the eyelid skin. Can J Ophthalmol 1990; 25:256–259. Cacciatori M, McLaren KM, Learns PP. Sarcoidosis presenting as a cutaneous eyelid mass. Br J Ophthalmol 1997; 81:329–330. Cook JR, Brubaker RF, Savell J, Sheagren J. Lacrimal sarcoidosis treated with corticosteroids. Arch Ophthalmol 1972;

88:513–517.

Hall JG, Cohen KL. Sarcoidosis of the eyelid skin. Am J Ophthalmol 1995; 119:100–101.

Hanno R, Neddelman A, Eiferman RA, Callen JP. Cutaneous sarcoid granulomas and the development of systemic sarcoidosis. Arch Dermatol 1981; 117:203–207.

Imes RK, Reifschneider JS, O’Connor LE. Systemic sarcoidosis presenting initially with bilateral orbital and upper lid masses. Ann Ophthalmol 1988; 20:466–467, 469.

Iwata K, Nanba K, Sobue K, Abe H. Ocular sarcoidosis: evaluation of intraocular findings. Ann NY Acad Sci 1976; 278:445–455.

Moin M, Kersten RC, Bernardini F, Kulwin DR. Destructive eyelid lesions in sarcoidosis. Ophthal Plast Reconstr Surg 2001; 17:123–125.

Pessoa de Souza Filho J, Martins MC, Sant’Anna AE, et al. Eyelid swelling as the only manifestation of ocular sarcoidosis. Ocul Immunol Inflamm 2005; 13:399–402.

Sharma OP. Cutaneous sarcoidosis. Clinical features and management. Chest 1972; 61:320–325. Zimmerman LE, Maumenee AE. Ocular aspects of sarcoidosis. Am Rev Respir Dis 1961; 84:38–50.

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Sebaceous Adenoma

INTRODUCTION Cutaneous adnexal neoplasms showing sebaceous differentiation are difficult to classify. Because of the intimate relationship of sebaceous glands with other adnexal structures associated with the pilosebaceous unit these lesions often display complex histologic features combining sebaceous, hair follicle, and sweat gland tissues. Sebaceous neoplasms run the gamut from benign to malignant lesions. These include sebaceous gland proliferation (sebaceous hyperplasia), congenital sebaceous hamartomas (nevus sebaceum), sebaceous adenoma, and sebaceous carcinoma. Sebaceous adenoma is an uncommon, often solitary lesion usually seen in patients over 40 years of age, with a predilection for the eyelid and brow, occurring in elderly patients.

CLINICAL PRESENTATION These present as a slowly enlarging well-demarcated firm dome-shaped lesion, generally less than 0.5 cm in diameter. They are smooth, yellow speckled papules, and sometimes may be pink to red. Fine telangiectatic vessels may be present within the lesion. Lesions are usually single, but in elderly patients may be multiple. Occasionally they may be polypoid or have a central umbilication. Occasionally they may ulcerate and bleed. Lesions may occur in combination with keratoacanthoma as part of the Muir-Torre syndrome (skin lesions occurring in association with an internal malignancy, typically adenocarcinoma of the colon), but here the sebaceous lesions tend to be cystic.

HISTOPATHOLOGY Sebaceous adenomas are composed of multiple sharply circumscribed sebaceous lobules. The tumor is usually located in the mid dermis, but it may connect to the epidermis. The

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Sebaceous Adenoma (Contd.)

sebaceous lobules comprising the tumor have a peripheral germinative layer of small basophilic cells, then a zone of transitional cells, and finally mature sebaceous cells in the center of the lobule. Mature sebaceous cells outnumber the germinative cells.

DIFFERENTIAL DIAGNOSIS The differential diagnosis includes benign lesions such as seborrheic keratosis, apocrine hidradenoma, nevus sebaceous, sebaceous hyperplasia, and dermoid cyst, as well as malignant tumors such as sebaceous cell carcinoma, and basal cell carcinoma.

TREATMENT Surgical removal is indicated for diagnosis or if there is a sudden increase in size. Complete excision with clear margins is necessary as incompletely excised lesions commonly recur. Alternative treatments include electrodessication and radiotherapy.

REFERENCES

Bhattacharya AK, Nayak SR, Kirtane MV, Ingle MV. Sebaceous adenoma in the region of the medial canthus causing proptosis. J Postgrad Med 1995; 41:87–88.

Finan MC, Connolly SM. Sebaceous gland tumors and systemic disease: a clinicopathologic analysis. Medicine (Baltimore) 1984; 63:232–242.

Font RL, Rishi K. Sebaceous gland adenoma of the tarsal conjunctiva in a patient with Muir-Torre syndrome. Ophthalmology 2003; 110:1833–1836.

Prioleau PG, Santa Cruz DJ. Sebaceous gland neoplasia. J Cutan Pathol 1984; 11:396–414.

Shlopova NB, Shlopov VG. Sebaceous gland adenoma of the eyelid. Vestn Oftalmol 1989; 105:76–78.

Singh AD, Mudhar HS, Bhola R, Rundle PA, Rennie IG. Sebaceous adenoma of the eyelid in Muir-Torre syndrome. Arch Ophthalmol 2005; 123:562–565.

Spraul CW, Jakobczyk-Zmija MJ, Lang GK. Sebaceous hyperplasia of the lower eyelid. Klin Monatsbl Augenheilkd 1999; 215:319–320.

Sebaceous Cell Carcinoma

INTRODUCTION Sebaceous cell carcinoma is a highly malignant neoplasm that arises from sebaceous glands, and the vast majority of these occur around the eyelids. It can derive from the meibomian glands, glands of Zeis, and from sebaceous glands associated with the pilosebaceous unit. Sebaceous cell carcinoma is an aggressive tumor with a high recurrence rate, a significant metastatic potential, and a notable mortality rate. Although relatively rare, sebaceous gland carcinoma represents the third most common eyelid malignancy, accounting for 1.0% to 5.5% of all eyelid cancers. It affects all races and occurs more commonly in women than in men. It usually presents in the sixth to seventh decades, but cases in younger patients, even children, have been reported. There is a clear link between sebaceous gland carcinoma and prior radiation therapy. It may invade locally into the globe, the orbit, the sinuses, or the brain. Metastases spread via local lymphatics to preauricular and submandibular lymph nodes or by hemotogenous spread to distant sites. Once metastases develop, the five-year survival rate is only 30% to 50%.

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Sebaceous Cell Carcinoma (Contd.)

CLINICAL PRESENTATION The upper eyelid is the site of origin in about two thirds of all cases, presumably due to a greater number of meibomian glands on the upper eyelid. The clinical appearance is varied and sebaceous cell carcinoma is very frequently misdiagnosed as a benign process. Often it presents as a firm, yellow nodule that resembles a chalazion. It can mimic a chronic blepharoconjunctivitis or meibomianitis that does not respond to standard therapies (the so-called masquerade syndrome). A more worrisome presentation may be as a plaque-like thickening of the tarsal plate with destruction of meibomian gland orifices and tumor invasion of eyelash follicles leading to madarosis, or loss of lashes. Tumor tends to invade the overlying epithelium which may result in the formation of nests of malignant cells. This is known as pagetoid spread. Pagetoid spread of the tumor may result in diffuse spread of the tumor that replaces the entire thickness of the conjunctiva (intraepithelial carcinoma) and mimics conjunctivitis. This lesion can exhibit multicentric spread to the conjunctiva, corneal epithelium and even to the other eyelid. It may also spread through the caniliculus to the lacrimal excretory system and the nasal cavity.

HISTOPATHOLOGY Sebaceous carcinoma varies from wellto poorly-differentiated tumors, depending on the number of neoplastic cells with sebaceous differentiation. The cells with sebaceous differentiation have abundant, finely vacuolated cytoplasm creating a foamy appearance. The other neoplastic cells have hyperchromatic nuclei, prominent nucleoli, and lightly basophilic cytoplasm. A lobular pattern of tumor is most common in the eyelid, though full-thickness involvement and Pagetoid spread of tumor cells in the conjunctiva or epidermis are also encountered. The tumor cells around the periphery of the lobules often have less cytoplasm and are more basophilic than those toward the center of the lobule. Oil red O stains for lipid within the tumor cells is rarely needed for diagnosis.

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Sebaceous Cell Carcinoma (Contd.)

DIFFERENTIAL DIAGNOSIS The differential diagnosis includes basal cell carcinoma, squamous cell carcinoma, papilloma, blepharitis, chalazion, ocular cicatricial pemphigoid, cutaneous horns, discoid lupus, pyogenic granulomas, lacrimal sac tumors, and superior limbic keratoconjunctivitis.

TREATMENT Any suspicious eyelid lesion or one that does not respond to medical therapy or recurs in the same location deserves a biopsy. Because eyelid margin sebaceous carcinomas often originate in the deep tarsus, superficial shave biopsies may reveal chronic inflammation but miss the underlying tumor. A full-thickness eyelid biopsy with permanent sections may be required to determine the correct diagnosis. Alternately, a punch biopsy of full-thickness tarsal plate may be diagnostic. Wide surgical excision with microscopic monitoring of the margins is the treatment of choice. Mohs’ micrographic surgical excision may be used, but it may not be as successful as in basal cell carcinoma or squamous cell carcinoma due to the possibility of multicentric skip lesions and pagetoid spread. If the tumor is very large or recurrent with spread to the bulbar conjunctiva or to orbital tissues, a subtotal or complete exenteration may be necessary. If evidence of spread to regional lymph nodes is present, the patient will require lymph node or radical neck dissection. Radiation therapy can be considered as an adjunct to local surgery. However, primary treatment with irradiation alone is inadequate, and recurrence usually occurs within three years.

REFERENCES

Boniuk M, Zimmerman LE. Sebaceous carcinoma of the eyelid, eyebrow, caruncle, and orbit. Trans Am Acad Ophthalmol Otolaryngol 1968; 72:619–641.

DePotter P, Shields CL, Shields CL. Sebaceous gland carcinoma of the eyelids. Int Ophthalmol Clin 1993; 33:5–9.

Dixon RS, Mikhail GR, Slater HC. Sebaceous carcinoma of the eyelid. J Am Acad Dermatol 1980; 3:241–243. Doxanas MT, Green WR. Sebaceous gland carcinoma. Arch Ophthalmol 1984; 102:245–249.

Dzubow LM. Sebaceous carcinoma of the eyelid: treatment with Mohs surgery. Dermatol Surg Oncol 1985; 11:40–44. Folberg R, Whitaker DC, Tse DT, Nerad JA. Recurrent and residual sebaceous carcinoma after Mohs’ excision of the primary

lesion. Am J Opthalmol 1987; 103:817–823.

Font RL. Eyelids and lacrimal drainage system. In: Spencer WH, ed. Ophthalmic Pathology: An Atlas and Textbook, 4th ed. Philadelphia: WB Saunders 1996:2218–2433.

Harvey JT, Anderson RL. The management of meibomian gland carcinoma. Ophthalmic Surg 1982; 13:56–61 . Kass LG, Hornblass A. Sebaceous carcinoma of the ocular adnexa. Surv Ophthlamol 1989; 33:477–490.

Khan JA, Grove AS, Joseph MP, Goodman M. Sebaceous gland carcinoma: diuretic use, lacrimal system spread, and surgical margins. Ophthalmic Plast Reconstr Surgery 1989; 5:227–234.

Kostick DA, Linberg JV, McCormick SA. Sebaceous gland carcinoma. In: Mannis MJ, Macsai MS, Huntley AC, eds. Eye and Skin Disease. Philadelphia: Lippincott-Raven Publishers 1996:413–417.

Lisman RD, Jakobiec FA, Small P. Sebaceous carcinoma of the eyelids. The role of adjunctive cryotherapy in the management of conjunctival pagetoid spread. Ophthalmology 1989; 96:1021–1026.

Ni C. Sebaceous cell carcinoma of the ocular adnexa. In: Ni C, Albert DM, eds. Tumors of the Eyelid. Vol. 22. Boston: Little Brown, 1982:23–61.

Nunery WR, Welsh MG, McCord CD Jr. Recurrence of sebaceous carcinoma of the eyelid after radiation therapy. Am J Ophthalmol 1983; 96:10–15.

Rao NA, Hidayat AA, McLean IW, Zimmerman LE. Sebaceous carcinoma of the ocular adnexa: a clinicopathological study of 104 cases. Hum Pathol 1982; 13:113–122.

Russell WG, Page DL, Hough AJ, Rogers LW. Sebaceous carcinoma of meibomian gland origin. The diagnostic importance of pagetoid spread of neoplastic cells. Am J Clin Pathol 1980; 73:504–511.

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Seborrheic Keratosis

INTRODUCTION Seborrheic keratosis is the most common eyelid tumor and the incidence increases with age. They are more common in light-skinned individuals. Also known as a senile verruca and seborrheic wart, this is a benign epithelial neoplasm that can occur on any part of the body. The reticulated type is usually found on the sun-exposed areas of the face and eyelids, and may develop from solar lentigines. These lesions usually affect middle-aged and older adults.

CLINICAL PRESENTATION Seborrheic keratoses initially present as painless, movable, sharply defined slightly elevated macules with a variable degree of pigmentation that varies from tan to brown. They sometimes appear in large numbers. As they grow they typically develop a greasy papillomatous or verrucous, stuck-on appearance. They are usually sessile, but can sometimes be pedunculated. Older lesions tend to be more verrucous and folded, with multiple keratin plugs creating a pitted surface. Irritation can cause inflammation, swelling, and sometimes bleeding, and crusting. In the variant called dermatosis papulosa nigra a large number of darkly pigmented lesions occurs on the cheeks of black patients. A rapid increase in size and number may represent the sign of Leser-Trélat (multiple eruptive seborrheic keratosis), which may occur in patients with an occult malignancy.

HISTOPATHOLOGY Seborrheic keratoses are sharply defined tumors that have multiple histological types that overlap frequently [acanthotic, papillomatous (hyperkeratotic), adenoid [reticulated], irritated, and clonal]. Acanthotic seborrheic keratoses (shown below) are encountered most frequently and are composed of broad columns of basaloid cells that interdigitate. Varying amounts of

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Seborrheic Keratosis (Contd.)

squamoid cells are admixed with the basaloid cells. Invaginations of keratin and horn cysts are typical features of acanthotic seborrheic keratosis.

DIFFERENTIAL DIAGNOSIS Seborrheic keratosis can be confused with melanocytic nevus, verruca vulgaris, actinic keratosis, pigmented basal cell carcinoma, and malignant melanoma.

TREATMENT These lesions are primarily of cosmetic concern only, although they can be an annoyance when they rub or catch on clothing. They may be removed for biopsy or cosmesis, or to prevent irritation. Therapy includes light cryotherapy followed by curettage, laser ablation, and surgical excision. They usually do not recur after treatment. Malignant melanoma has been reported within a seborrheic keratosis. In up to 10% of lesions they may not be able to be distinguished from melanoma so that biopsy is appropriate if there is any doubt about the diagnosis.

REFERENCES

Cribier B. Seborrheic keratosis. Ann Dermatol Venereol 2005; 132:292–295. Ellis DL, Yates RA. Sign of Leser-Trelat. Clin Dermatol 1993; 11:141–148.

Harrison MA Jr, Reed RN, Derbes VJ. Dermatosis papulosa nigra. Arch Dermatol 1964; 89:655.

Herron MD, Bowen AR, Krueger GG. Seborrheic keratosis: a study comparing the standard cryosurgery with topical calcipotriene, topical tazarotene, and topical imiquimod. Int J Dermatol 2004; 43:300–302.

Kobalter AS, Roth A. Benign epithelial neoplasms. In: Mannis MJ, Macsai MS, Huntley AC, eds. Eye and Skin Disease. Philadelphia: Lippincott-Raven Publishers, 1996:345–355.

Sanderson KV. The structure of seborrheic keratosis. Br J Dermatol 1963; 80:588–593. Scully J. Treatment of seborrheic keratosis. JAMA 1970; 213:1498.

Thomas I, Kihiczak NI, Rothenberg J, Ahmed S, Schwartz RA. Melanoma within the seborrheic keratosis. Dermatol Surg 2004; 30:559–561.

Squamous Cell Carcinoma

INTRODUCTION Squamous cell carcinoma is a malignant tumor that most commonly affects elderly, fairskinned individuals. It arises from keratinocytes of the epidermis. Unlike the more common basal cell carcinoma, squamous cell carcinoma tends to arise in precancerous areas of skin alteration or in areas of skin damaged by chronic sun exposure, ionizing radiation, carcinogens (e.g., arsenic), psoralen plus ultraviolet A (PUVA) therapy for psoriasis, and the human papilloma virus. Intrinsic factors that may contribute to its development include xeroderma pigmentosum, oculocutaneous albinism, and immunodeficiency. Chronic skin dermatoses, inflammation, ulceration, and contracted scars also are associated with the development of this tumor. In fact, scarring of the skin is the most common intrinsic factor leading to this tumor in black patients. Lymphatic spread and perineural invasion are possible.

CLINICAL PRESENTATION The most common site of eyelid involvement is the lower lid. Initial changes can look like a chronic eczema-like lesion. The tumor often originates in an actinic keratosis, but tends to be thicker, larger and have a more heaped-up keratinization. These lesions have a

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Squamous Cell Carcinoma (Contd.)

tendency to ulcerate, and growth may be endophytic or more exophytic with raised papillary verrucous borders. Occasionally it can take on the appearance of a cutaneous horn. Long-standing lesions become friable and bleed easily. Necrosis may follow with superimposed bacterial infection. Orbital extension has been reported in up to 16% of cases. Palpable regional lymph nodes indicate metastatic spread.

(Courtesy of Richard L. Anderson, M.D.)

HISTOPATHOLOGY The typical squamous cell carcinoma has nests and tongues of squamous epithelial cells that arise from the epidermis and extend into the dermis. Squamous cells are recognizable by their eosinophilic cytoplasm and large nuclei. Keratinization and horn pearl formation are present in tumors that are better differentiated. A mild to moderate infiltrate of lymphocytes around the periphery of the tumor is common.

DIFFERENTIAL DIAGNOSIS The differential diagnosis includes basal cell carcinoma, sebaceous cell carcinoma, Bowen’s disease, actinic keratosis, keratoacanthoma, inverted follicular keratosis, papilloma, pseudoepitheliomatous hyperplasia, seborrheic keratosis, trichilemomma, fungal infection, and verruca vulgaris.

TREATMENT Diagnosis requires a biopsy for histologic confirmation. Once the diagnosis is established the goal of therapy is complete removal of tumor cells with preservation of unaffected eyelid and periorbital tissues needed for reconstruction. Mohs’ micrographic surgery provides the highest

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Squamous Cell Carcinoma (Contd.)

cure rate with the most effective preservation of normal tissue. Excisional biopsy with frozen section control is an acceptable alternative technique. Radiation therapy is generally not recommended as the initial treatment, but it may be useful in the treatment of advanced or deeply invasive recurrent lesions. Doses are in the range of 4000 to 7000 cGy. A recurrence rate of 12% with radiation has been reported. Cryotherapy is often used to treat nonperiorbital lesions, but when applied to the eyelids complications such as marginal notching, ectropion, sympblepharon formation, fornix foreshortening, and depigmentation of eyelid skin have all been reported. Cryotherapy is also associated with a higher recurrence rate. Advanced cases may be associated with metastasis to the pre-auricular and submandibular lymph nodes, which heralds a more guarded prognosis. Invasion into deep orbital tissues can be seen, often requiring orbital exenteration for definitive management.

REFERENCES

Bowyer JD, Sullivan TJ, Whitehead KJ, Kelly LE, Allison RW. The management of perineural spread of squamous cell carcinoma to the ocular adnexae. Ophthal Plast Reconstr Surg 2003; 19:275–281.

Dailey JR, Kennedy RH, Flaharty PM, Eagle RC Jr, Flanagan JC. Squamous cell carcinoma of the eyelid. Ophthalmol Plast Reconstr Surg 1994; 10:153–159.

Donaldson MJ, Sullivan TJ, Whitehead KJ, Williamson RM. Squamous cell carcinoma of the eyelids. Br J Ophthalmol 2002; 86:1161–1165.

Doxanas MT, Iliff NT, Green WR. Squamous cell carcinoma of the eyelids. Ophthalmology 1987; 94:538–541.

Epstein E, Epstein NN, Bragg K, Linden G. Metastases from squamous cell carcinoma of the skin. Arch Dermatol 1968; 97:245–251.

Font RL. Eyelids and lacrimal drainage system. In: Spencer WH, ed. Ophthalmic Pathology: An Atlas and Textbook. 4th ed. Vol. 4. Philadelphia: WB Saunders, 1996:2218–2433.

Hass AF, Tucker SM. Squamous cell carcinoma. In: Mannis MJ, Macsai, Huntley AC, eds. Eye and Skin Disease. Philadelphia: Lippincott-Raven Publishers, 1996:405–411.

Kwitko ML, Boniuk M, Zimmerman LE. Eyelid tumors with reference to lesions confused with squamous cell carcinoma. I. Incidence and errors in diagnosis. Arch Ophthalmol 1963; 69:693–697.

Lederman M. Discussion of carcinomas of conjunctiva and eyelid. In: Boniuk M, ed. Ocular and Adnexal Tumors. St Louis: CV Mosby, 1964:104–109.

Lund HZ. How often does squamous cell carcinoma of the skin metastasize? Arch Dermatol 1965; 92:635–637. Mencia-Gutierrez E, Fernandez Gonzalez MC, Gutierrez Diaz E, et al. Squamous cell carcinomas of the eyelids: 18 cases.

Arch Soc Esp Oftalmol 2000; 75:665–669.

Mora RG, Perniliaro C. Cancer of the skin in blacks. I. A review of 163 black patients with cutaneous squamous cell carcinoma. J Am Acad Dermatol 1981; 5:405–411.

Reifler DM, Hornblass A. Squamous cell carcinoma of the eyelid. Surv Ophthalmol 1986; 30:349–365.

Syringoma

INTRODUCTION Syringoma is a common adnexal tumor formed by well-differentiated ductal elements. Immunohistochemistry shows the presence of eccrine enzymes and the pattern of cytokine expression suggests differentiation toward the uppermost part of the dermal duct. It is unclear if these lesions represent true adnexal neoplasms or a hyperplastic response to an inflammatory reaction. These lesions are mostly benign, asymptomatic and occur primarily in young females. A very rare malignant syringoma has been described on the eyelids, characterized by larger size, isolated nature, and subcutaneous and perineural invasion.

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Syringoma (Contd.)

CLINICAL PRESENTATION The lesions typically occur at the time of puberty and present as multiple small (1–3 mm), skin-colored to yellowish papules with a rounded or flat surface. They can sometimes appear translucent or cystic. Lesions are usually multiple and distributed symmetrically on the upper cheek and lower eyelids.

(Courtesy of Robert A. Goldberg, M.D.)

HISTOPATHOLOGY Syringomas are dermal tumors composed of small ductules usually lined by two layers of flattened cuboidal cells. An epithelial strand at the end of a ductule may create a tadpole or comma-like appearance. Solid nests and strands of epithelial cells are also present commonly. The lack of deep extension and perineural invasion differentiates syringoma from microcystic adnexal carcinoma.

DIFFERENTIAL DIAGNOSIS The differential diagnosis includes flat warts, milia, sarcoid nodules, trichoepithelioma, and basal cell carcinoma.

TREATMENT Syringomas are of cosmetic concern only. The most common forms of treatment include surgical excision, electrodessication, CO2 laser ablation, tricholoracetic acid, and cryotherapy. All forms of treatment carry a risk of scarring and the cosmetic result following removal may be less acceptable than the original condition.

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