Chondroid syringoma with osteoma cutis.

Clinical presentation

A 26-year-old man presented with an asymptomatic, slow-growing nodule on upper portion of the left cutaneous lip that had been present for approximately 2 years. He denied any bleeding, ulceration, or prior trauma to that area. Physical examination demonstrated a smooth-surfaced, firm, pedunculated nodule measuring approximately 1.1 cm in diameter (Fig 1).

Fig 1

Smooth-surfaced, pink pedunculated nodule on the upper portion of the left cutaneous lip.

Dermatoscopic appearance

Nonpolarized dermatoscopy revealed a light pink nodule with white pleomorphic globules and irregularly enlarged branching telangiectasias conferring a marbled appearance (Fig 2).

Fig 2

Nonpolarized dermatoscopic view of a pink nodule with white pleomorphic globules and irregularly enlarged branching telangiectasias.

Histologic diagnosis

Histology demonstrated a well-circumscribed lobulated dermal nodule composed of epithelial structures in a myxomatous and chondroid stroma with irregular branching tubules and ducts. Calcium was present as well as focal areas of ossification (Fig 3, A-C).

Fig 3

Histopathology revealing multiple epithelial structures in a chondromyxoid stroma with irregular branching ducts and focal areas of calcification and ossification (A-C, Hematoxylin-eosin stain; original magnifications: A, ×2; B ×4; C, ×10).

Chondroid syringomas represent a relatively rare, mixed tumor of the skin that is thought to be of apocrine or eccrine origin. They commonly present as an asymptomatic, slow-growing nodule on the head and neck of older men. Histologically, they present with varying ductal epithelial structures distributed within a chondromyxoid and fibrous stroma. The presence of ossification in chondroid syringoma is exceedingly rare. Dermatoscopy can provide an adjunctive measure for diagnosis of this adnexal neoplasm. The most predominant dermatoscopic feature for distinguishing dystrophic calcification and ossification in this tumor is the presence of white pleomorphic dots and globules, which, combined with the arborizing-like vessels, impart a marbled appearance. This is a novel dermatoscopic feature not previously reported. Definitive treatment is by wide local excision with clear margins for prevention of recurrence.

Conflicts of interest

None disclosed.