Pictorial case study: Syringomas

The case  

An 84-year-old woman attended about a small lesion on her cheek that was thought to be an early rodent ulcer. While she was there, her GP noticed numerous small, smooth coloured papules, symmetrically on the eyelids and around the eyes. The patient said they had been there as long as she could remember, at least 60 years. They did not bother her and she saw no reason to have treatment or undergo skin biopsy.  

Diagnosis and management  

The lesions and history in this woman were typical of syringomas — benign tumours of the sweat ducts which tend to make their appearance in adult life. They are more common in women and are seen mostly around the eyes, but they do occur elsewhere on the face, armpits, chest or lower abdomen. Treatment is generally unnecessary but diathermy or laser treatments are available. The patient should be warned that they could be left with small scars.  

The diagnosis of syringoma can usually be made on clinical grounds from the appearance of the lesions. If in doubt, skin biopsy will provide characteristic microscopic changes. 

Possible different diagnoses  

  • Xanthelasma.  
  • Trichoepithelioma.  
  • Basal cell carcinoma.  

Differential diagnosis  

Basal cell carcinoma

  • Commonest form of skin cancer.
  • Lesions may be multiple and appear on light-exposed areas.
  • Occur most commonly on the face.  
  • Requires excision and may need radiotherapy, cryotherapy, curettage and cautery.  

Contributed by Dr Jean Watkins, a GP in Ringwood, Hampshire

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