Syringomas are common benign adnexal neoplasms of eccrine duct derivation that present most frequently in females on the face, especially around the eyes (Fig. 48.1). They may also be seen on the chest, umbilicus, axillae, and vulva.
Infraorbital syringomas being treated with low setting electrocautery on a young female. The treatment was not effective.
Age: usually present at puberty
Precipitating factors: more common in Down’s syndrome
These benign symmetric, well-circumscribed dermal tumors are composed of multiple small ducts with two layers of cuboidal epithelium, often with a “tail” giving a “tadpole,” or comma-like appearance in the upper dermis. These ducts are sometimes dilated and are lined by an eosinophilic cuticle. There is a surrounding dense fibrous eosinophilic stroma.
Skin-colored to yellow, 1- to 3-mm firm papules. They are seen most frequently around the eyes, especially the lower eyelid. Typically, they are multiple and symmetric. They can also be seen on the chest, umbilicus, axillae, and genitalia (Fig. 48.2). Acral lesions are seen in eruptive syringomas.
(A) Infraorbital syringomas in a young female. (B) Follow-up picture at 1 week after ablative fractional CO2 laser resurfacing showing improvement of the syringomas. This improvement is attributed mostly to the postprocedure edema. No significant improvement was noted at a later follow up
Milia, sebaceous hyperplasia, basal cell carcinoma, trichoepithelioma, fibrous papule,
Biopsy may be indicated if basal cell carcinoma is suspected. No other laboratories are indicated.
They present at puberty and do not resolve without intervention.
KEY CONSULTATIVE QUESTIONS
There is no medical indication to treat syringomas. Many patients, however, request treatment for cosmetic appearance. Syringomas are therapeutically challenging. Although there are multiple treatment modalities available, none is completely successful in complete or permanent removal of syringomas. Often, the side effects of treatment will bother patients more than the syringomas themselves. Ideally, the treatment of syringomas should produce destruction of the tumor with minimal scarring and no recurrence. There are no effective topical medications.