Syringoma — SCE Dermatology MCQ

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EasyInflammatory DermatosesSyringomaSCE Dermatology

A 48-year-old woman presents with multiple firm skin-coloured papules on her face concentrated around the eyes. They are 1-3 mm and dome-shaped. She has had them for years and they are gradually increasing. Biopsy shows well-circumscribed dermal proliferation of eccrine ducts. What is the diagnosis?

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Correct answer: E — Syringoma

The correct answer is E, Syringoma. Syringomas are benign adnexal tumours arising from the intraepidermal (acrosyringeal) portion of the eccrine sweat duct, and they characteristically present as multiple small, firm, skin coloured, dome shaped papules of 1 to 3 mm clustered around the eyes, particularly the lower eyelids, in middle aged women, slowly increasing in number over years. The histological description of a well circumscribed dermal proliferation of eccrine ductal structures (classically comma or tadpole shaped ducts in a fibrous stroma) confirms eccrine differentiation and excludes the other papular differentials. The combination of periorbital distribution, small uniform size, chronic indolent course and eccrine ductal histology is pathognomonic for syringoma. Why the other options are wrong: C. Milia: these are small keratin filled epidermoid cysts, histologically showing a cyst lined by stratified squamous epithelium containing laminated keratin, not a proliferation of eccrine ducts. B. Fibrous papule: this is a solitary lesion, typically on the nose, composed of dermal fibrosis with stellate fibroblasts and dilated vessels, not multiple periorbital ductal structures. A. Trichoepithelioma: this arises from hair follicle differentiation and shows basaloid nests with horn cysts and papillary mesenchymal bodies, not eccrine ducts, and tends to occur on the central face rather than exclusively periorbitally. D. Xanthelasma: these are yellowish plaques on the eyelids composed of lipid laden foamy macrophages (xanthoma cells) in the dermis, not ductal epithelial structures, and are typically flatter plaques rather than firm dome shaped papules. Key point: multiple firm skin coloured periorbital papules with dermal eccrine ductal proliferation on biopsy (comma or tadpole shaped ducts) defines syringoma, distinguishing it from milia, fibrous papule, trichoepithelioma and xanthelasma.

Reference: Primary Care Dermatology Society (PCDS), Clinical Guidance: Syringoma (syn. syringocystadenoma, syringocystoma), https://www.pcds.org.uk/clinical-guidance/syringoma-syn-syringocystadenoma-syringocystoma