Skin nonmelanocytic tumor

• Most often presents on nose, cheeks and forehead
• Occasionally appears on chest, areola, mouth, scrotum, foreskin, shaft of penis or vulva (Int J Dermatol 1991;30:306, BMJ Case Rep 2014;2014:bcr2014204025, Ann Dermatol 2011;23:S341, Ginekol Pol 2023;94:509)

• Sebaceous glands are highly sensitive to androgens: decreasing levels of androgens with aging → lowers sebocytes turnover → feedback stimulates proliferation → sweat gland hyperplasia
• Positive feedback from hormonal influences, such as hydrocortisone, thyroid stimulating hormone (TSH) and insulin, leads to sebaceous hyperplasia (Ginekol Pol 2023;94:509)
• Other factors that can promote sebaceous gland hyperplasia: ultraviolet exposure, hydrocortisone
• Some medications, such as immunotherapeutic medication and specifically cyclosporine, HIV antiretroviral treatment and steroids (J Drugs Dermatol 2018;17:118, Clin Exp Dermatol 2008;33:354)

• Soft, discrete, yellow-white or skin colored papules with central umbilication, usually incidentally discovered and described as asymptomatic; patients can present for cosmetic concerns
• Several variants exist: singularly, grouped, diffuse, extensive or juxtaclavicular beaded lines
• Juxtaclavicular beaded lines are characterized as papules arranged in parallel rows within the skin of the neck and overlying the clavicle (J Cutan Pathol 1991;18:464)

• Presumptive diagnosis is made using clinical examination; confirmatory diagnosis can be made upon biopsy and subsequent histologic examination

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Contributed by Sepideh Nikki Asadbeigi, M.D.

A 36 year old woman presents to the clinic with several 2 - 6 mm, whitish yellow papular lesions on her face that were first noticed 3 months prior to her visit. Biopsy reveals an expansion of normal lobular sebaceous gland architecture without atypia. Which of the following is the most likely diagnosis?

1. Sebaceoma
2. Sebaceous adenoma
3. Sebaceous carcinoma
4. Sebaceous hyperplasia

D. Sebaceous hyperplasia. The clinical presentation and microscopic description are typical for sebaceous gland hyperplasia, a benign entity in which there is an expansion of sebaceous glands without mitosis, necrosis or atypia. Answer A is incorrect because in sebaceoma, there is a basaloid growth pattern into the dermis. Answer B is incorrect because epidermal thickening and hyperplasia can be noted under microscopic examination. Answer C is incorrect because in sebaceous carcinoma, there is usually a lobular or sheet-like growth pattern with multivacuolated cells.

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Reference: Sebaceous hyperplasia

A 38 year old woman has been recently diagnosed with sebaceous gland hyperplasia. Which of the following most likely contributed to her condition?

1. Androgen withdrawal
2. Chronic sun exposure
3. Inactivating mutation in LEF1 gene
4. Insulin insensitivity

A. Androgen withdrawal. Androgen withdrawal is believed to be the etiology of sebaceous gland hyperplasia. Answer C is incorrect because inactivating mutations in LEF1 gene can contribute to subsets of sebaceous adenoma. Answer D is incorrect because insulin insensitivity is associated with other dermatologic conditions, such as acrochordon and acanthosis nigricans. Answer B is incorrect because chronic sun exposure would be a risk factor for some skin malignancies, such as basal cell carcinoma.

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Reference: Sebaceous hyperplasia