Dermatology: Practical and Conceptual Research Letter | Dermatol Pract Concept. 2023;13(4):e2023239 1 Syringocystadenoma Papilliferum of the Eyelid, an Unusual Presentation: A Case Series Omar Loza-Escutia1, Juan Alberto Godínez-Chaparro2, Rosa María Guevara Castillo3, Marissa de Jesús Quintal-Ramírez4, Elizabeth Natalia Quispe Susara4 1 Dermatology service, Hospital General Regional No. 2, Instituto Mexicano del Seguro Social, Mexico City, Mexico 2 Pediatric Dermatology Service, Centro Médico Nacional la Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico 3 Department of Dermatology, Centro Médico Nacional la Raza, Instituto Mexicano del Seguro Social, México City, Mexico 4 Department of Pathology, Centro Médico Nacional la Raza, Instituto Mexicano del Seguro Social, México City, Mexico Key words: syringocistadenoma papilliferum, adnexal tumor, eyelid, dermoscopy Citation: Loza-Escutia O, Godínez-Chaparro JA, Guevara Castillo RM, Quintal-Ramírez MJ, Quispe Susara EN. Syringocystadenoma Papilliferum of the Eyelid, an Unusual Presentation: A Case Series. Dermatol Pract Concept. 2023;13(4):e2023239. DOI: https://doi.org/10 .5826/dpc.1304a239 Accepted: May 1, 2023; Published: October 2023 Copyright: ©2023 Loza-Escutia et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Omar Loza-Escutia, Current Address: Tuxpan 28, 202-A Roma Sur, Cuauhtémoc, CP:06760 Mexico City, Mexico. Phone: 52 55 43 42 02 18 E-mail: omar_loza7@hotmail.com Introduction Syringocystadenoma papilliferum (SCAP) is a benign adnexal tumour originated from the apocrine and eccrine glands [1]. It may grow de novo or from another preexisting adnexal tumor.1 The eyelid topography is extremely unusual [2]. Case Presentation Case #1 An 80-year–old Mexican female presented a lesion of 3 years of evolution on the medial margin of the left upper eyelid. She had an itchy, coarse, crusted, solitary nodule, measur- ing 0.6 x 0.3 cm (Figure 1A). A dermoscopic examina- tion (10x) revealed a lesion with monomorphous septated vascular structures surrounded by a whitish halo (Figure 1B). Histologic examination demonstrated several cystic and ductal invaginations spreading from the epidermis and pap- illary projections covered by a double row of epithelial cells (Figure 1C), the stroma had countless plasma cells. It was diagnosed as a SCAP and completely resected. Case #2 A 51-year-old Mexican male presented a lesion of 10 years of evolution localized on the lateral margin of the left lower eyelid. He had an itchy, erythematous, rough, solitary nod- ule, measuring 0.8 x 0.5 cm (Figure 2A). Dermoscopic and histologic findings observed in this case were like the previ- ous one (Figure 2 B and C). A SCAP was diagnosed, and the patient was sent to plastic surgery for its resection. 2 Research Letter | Dermatol Pract Concept. 2023;13(4):e2023239 Conclusions SCAP may be presented on any part of the body and oc- casionally affects the eyelid skin [1]. SCAP is a lesion pre- sented more frequently in women (62%) and the mean age at diagnosis is 43.9 years [1]. The size of the lesion often ranges from 4 mm to 25 mm, with a median of 7 mm [1]. Comparatively, our patient lesions sizes were close the re- ported median. The frequency of this localization is higher on the upper right eyelid on the lateral margin [1]. In both our cases, lesions were found on the left eyelids, albeit at different palpebral topography. Dermoscopic descriptions of SCAP are scarce, neverthe- less, and concordantly with our cases, exophytic papillary structures can be appreciated, surrounded by a whitish halo, central ulcerations, or erosions with crusts; polymorphous vessels with predominance of hairpin and coma pattern [2]. The diagnosis confirmation is made by histopathology [1]. Some other tumors must be differentiated from SCAP, such as warts, seborrheic keratoses, basal cell carcinomas and squamous cell carcinomas. There are some dermoscopic features that may help differentiate SCAP from these enti- ties: a) warts exhibit papillary growths, bleeding, dotted and linear vessels, b) seborrheic-keratoses present fissures and ridges, comedo-like openings, milia like cysts and hairpin blood vessels surrounded by whitish halo, c) basal cell carci- nomas reveal arborizing and linear vessels running parallel to each other and perpendicular to the eyelid margin; dots and globules were seen in pigmented lesions, d) squamous cell carcinomas show glomerular or linear vessels, central keratin plugs, erosions and ulcerations above a white, pink or mixed background [3-6]. Figure 1. Case #1. (A) Clinical image (black arrow). (B) Dermoscopic image (10x): vascular structures surrounded by whitish halo (black arrow). (C) Histopathology: invaginations (black arrow) and papillomatous projections (green arrow). (D) Double row of epithelial cells (white arrow), plasma cells infiltration in the stroma (blue arrow) and decapitation secretion (red arrow). Research Letter | Dermatol Pract Concept. 2023;13(4):e2023239 3 Considering that the malignancy transformation risk has been reported as 3.7%, its complete excision is recom- mended [1]. SCAP is a rare neoplasia which very rarely presents on the eyelids. Dermoscopic exploration can shed useful insight when assessing all the relevant differential diagnoses. References 1. Tseng MC, Amin B, Barmettler A. Eyelid syringocystadenoma papilliferum: A novel presentation with major review. Orbit. 2018;37(3):171-174. DOI: 10.1080/01676830.2017.1383477. PMID: 29053036. 2. Chauhan P, Chauhan RK, Upadhyaya A, Kishore S. Dermoscopy of a rare case of linear syringocystadenoma papilliferum with re- view of the literature. Dermatol Pract Concept. 2018;8(1):33-38. DOI: 10.5826/dpc.0801a07. PMID: 29445572. PMCID: PMC5808369. 3. Al Rudaisat M, Cheng H. Dermoscopy Features of Cutaneous Warts. Int J Gen Med. 2021; 14:9903-9912. DOI: 10.2147/ IJGM.S335276. PMID: 34938109. PMCID: PMC8687684. 4. Minagawa A. Dermoscopy-pathology relationship in seborrheic ker- atosis. J Dermatol. 2017; 44(5):518-524. DOI: 10.1111/1346-8138 .13657. PMID: 28447350. 5. Vaccari S, Barisani A, Schiavi C, et al. Basal cell carcinoma of the eyelid margin: Dermoscopic clues in a case series. Dermatol Ther. 2021;34(4): e15006. DOI: 10.1111/dth.15006. PMID: 34043265. 6. Sgouros D, Theofili M, Damaskou V, et al. Dermoscopy as a Tool in Differentiating Cutaneous Squamous Cell Carcinoma from Its Variants. Dermatol Pract Concept. 2021;11(2): e2021050. DOI: 10.5826/dpc.1102a50. PMID: 33954021. PMCID: PMC8060018. Figure 2. Case #2. (A) Clinical image (black arrow). (B) Dermoscopic image (10x): septated vascular structures surrounded by whitish halo (black arrow). (C) Histopathology: ductal invaginations from epidermis (black arrow) and papillary projections (yellow arrow). (D) Double row of epithelial cells (black arrow) with a dense infiltration of plasma cells in the stroma (yellow arrow) and a secretion through decapita- tion (red arrow).