Randy Jacobs, M.D. Patient Education
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Syringoma
The syringoma, a benign sweat duct tumor, belongs to the
classification of skin neoplasms known as the "skin appendage
tumors"--thus called because they display certain structural similarities
to the hair follicle, the sebaceous gland, the epidermis, the apocrine gland,
or the eccrine gland. Due to its line of
differentiation, the syringoma is categorized as an eccrine appendage tumor (along with the eccrine nevus, hydrocystomas, spiradenomas,
and others). Occurring more often in females than males, syringomas may develop at any age, but appear most often in the early teen years and
progressively become more numerous throughout life. Their areas of distribution
include the axillae, umbilical, and pubic areas, and less commonly the
forehead. There are also cases of syringomas in which
the lesions are limited to the lower eyelids. Grossly, the lesions appear as
skin colored or slightly yellowish firm papules ranging from one to three
millimeters in size. And in the eruptive form they arise in successive crops on
the anterior truck and abdomen. Histopathologically,
the upper and mid-dermis contain numerous small cystic ducts, and solid
epithelial strands embedded in a fibrous storm. Under electron microscopy the
strands of epithelial cells and outer layers of the ducts are identical to
those composing the outer layers of the embryonic eccrine sweat ducts. Further support as to the origin of these tumors is that the tumor
cells contain all the eccrine types of enzymes. Many
of the less mature tumors, including the syringoma,
exhibit marked similarities tot he corresponding embryonic appendages. But this
similarity does not conclude that these tumors originate from dormant embryonic
tissue, but signifies that they are as equally immature. In accordance with
their immature appearance, these tumors also possess the same abilities of the
matrix cells of the epidermis and its appendages. Thus, these tumors
theoretically possess the lifelong capability to differentiate into any other
type of skin appendage and any tumor derived from that particular appendage. At
present, it is not known what the specific causes are that initiate the
conversion of normal cells into tumor cells. But it does appear that the benign
immature skin tumors represent certain stages in the differentiation of certain
matrix cells towards their mature counterparts (e.g. eccrine,
apocrine, pigmentary hair or sebaceous nevi).
Concerning treatment, as stated earlier, the lesions are benign with no
malignant potential, and except for cosmetic purposes, no treatment is
necessary. But if so desired, they can be easily destroyed by superficial
electrocoagulation, laser, epilation, curettage, or excision. The scars may not
be worth the effort to remove the syringomas.