Dermoscopy of Syingoma.

A 40-year-old female presented with multiple asymptomatic lesions over face since 2 years. There were multiple, 2–3 mm size, skin colored papules over bilateral cheeks, around eyes, and nose [Figure 1].

Figure 1

Multiple skin colored, 2–3 mm papules over bilateral cheeks and nose

Dermoscopy (DermLite 3Gen; polarized mode, 10× magnification) of papules revealed multiple pigmented clusters. These pigmented clusters consisted of brown pseudonetwork and multiple white dots which appeared larger than those over uninvolved skin [Figure 2]. These are consistent with previously described features.[1]

Figure 2

Multiple pigmented clusters of brown pseudonetwork (circle) and multiple white dots (arrow) (DermLite 3Gen; polarized mode, 10× magnification)

A punch biopsy from papule revealed nests, cords, and tubules of epithelial cells arranged in dense fibrous stroma. Ducts were lined by double cuboidal epithelium with a comma-like tail (tadpole appearance) [Figure 3]. Biopsy confirmed the diagnosis of syringoma. White dots seen on dermoscopy correlated to dilated eccrine ducts seen on histopathology.

Figure 3

Multiple nests, cords, and ducts of epithelial cells with a comma-like tail (tadpole appearance) in dense fibrous stroma. Few ducts showing eosinophilic material (H and E, 10×)

Syringoma is a benign adnexal tumor derived from intraepidermal eccrine ducts which occur predominantly in women in early adulthood over face. Skin biopsy of facial lesion is often not acceptable due to cosmetic concern. Dermoscopy being easy, rapid noninvasive technique helps to differentiate syringoma from other skin colored papules and increase the clinical diagnostic accuracy. The dermsocopic findings of various differentials of syringoma are tabulated in [Table 1].

Table 1

Dermoscopy of various differentials of syringoma

Differentials of syringoma	Dermoscopic features
Sebaceous hyperplasia[1]	Yellow white globules, crown vessels
Milia[1]	White to yellow homogeneous areas, brown peripheral rim, linear vessels
Hidrocystoma[1]	Yellowish-brown homogeneous area, linear irregular vessels , white globules
Trichoepithelioma[2]	Arborizing vessels, multiple milia-like cysts, and rosettes amidst a whitish background
Comedones[3]	Circular homogenous, light- or dark-brown located superficially in the epidermis
Adenoma sebaceum[4]	Multiple yellowish-white dots distributed over a pinkish-gray background

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Conflicts of interest

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