DermDx: Flesh-Colored Papule

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A 64-year-old Hispanic man is referred for evaluation of several skin lesions on his face that have been present for at least 1 year. The lesion of most concern is a flesh-colored papule under his right eye. He has no history of skin cancer or other types of malignancy and the lesion in question (denoted by ink) has never bled.

Biopsy of the lesion revealed sebaceous hyperplasia, a commonly encountered benign proliferation of sebaceous glands that affects middle-aged to elderly adults, most commonly in men.1 Approximately 1% of the population is affected.1 Lesions usually present as asymptomatic, dome-shaped papules with...

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Biopsy of the lesion revealed sebaceous hyperplasia, a commonly encountered benign proliferation of sebaceous glands that affects middle-aged to elderly adults, most commonly in men.1 Approximately 1% of the population is affected.1 Lesions usually present as asymptomatic, dome-shaped papules with a central umbilication located on the cheeks and forehead. Factors linked to pathogenesis include sun exposure and immunosuppressive drugs.2 Uncommonly encountered variants are a giant form (>10 mm) and linear sebaceous hyperplasia affecting pre- and retro-auricular, neck, and chin areas.3

Most cases of sebaceous hyperplasia are readily diagnosed clinically. Dermoscopy may aid in differentiation from molluscum and basal cell carcinoma. Findings often include so-called “crown vessels” that extend toward the center of the lesion without crossing the midline.4 Histopathology reveals enlarged glands connected to a sebaceous duct. Lesions respond to cryosurgery, electrodesiccation, and laser ablation. When lesions are multiple and/or refractory to treatment, isotretinoin has proven of value.5 

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. Farci F, Rapini RP. Sebaceous hyperplasia. In: StatPearls [Internet]. StatPearls Publishing; 2021. Updated September 9, 2021. Accessed September 21, 2022.  https://www.ncbi.nlm.nih.gov/books/NBK562148/
  2. Zouboulis CC, Boschnakow A. Chronological ageing and photoageing of the human sebaceous gland. Clin Exp Dermatol. 2001;26(7):600-607. doi:10.1046/j.1365-2230.2001.00894.x
  3. Sato T, Tanaka M. Linear sebaceous hyperplasia on the chest. Dermatol Pract Concept. 2014;4(1):93-95. doi:10.5826/dpc.0401a16
  4. Kim NH, Zell DS, Kolm I, Oliviero M, Rabinovitz HS. The dermoscopic differential diagnosis of yellow lobularlike structures. Arch Dermatol. 2008;144(7):962. doi:10.1001/archderm.144.7.962
  5. Tagliolatto S, Oliverira Santos Neto O, Avelar Alchorne MM, Enokihara MY. Sebaceous hyperplasia: systemic treatment with isotretinoin. An Bras Dermatol. 2015;90(2):211-215. doi:10.1590/abd1806-4841.20153192

This article originally appeared on Clinical Advisor