How Would You Diagnose This Papule?

Author:
David L. Kaplan, MD—Series Editor

Citation: 
Kaplan DL. How would you diagnose this papule? Consultant. 2018;58(7):164-165.

This 53-year-old woman presented for evaluation of a persistent asymptomatic papule on the lateral canthus of her right eyelid. She denied any bleeding from the site or a history of trauma. She was otherwise healthy.

Answer: Hidrocystoma

Hidrocystomas are benign cystic tumors of the apocrine sweat glands. They usually occur on the face of middle-aged and elderly women, with solitary lesions found on the eyelid, and this patient follows the trends described in the literature. Cystic basal cell carcinoma is a rare mimicker that needs to be considered in the differential diagnosis. When in doubt, biopsy is definitive. For both hidrocystoma and basal cell carcinoma, a superficial shave removal of the top of the lesion will provide histologic confirmation of the diagnosis. For hidrocystomas, this diagnostic maneuver will often result in eradication of the cyst with an excellent cosmetic result.

Periorbital dermatitis and lupus miliaris disseminatus faciei usually are characterized by multiple lesions that are erythematous, unlike what is seen in the case of the patient presented here. Molluscum contagiosum lesions present as umbilicated papules, unlike what is seen here. 

David L. Kaplan, MD, is a clinical assistant professor of dermatology at the University of Missouri–Kansas City School of Medicine in Kansas City, Missouri, and at the University of Kansas School of Medicine in Kansas City, Kansas. He practices adult and pediatric dermatology in Overland Park, Kansas.