The store-and-forward feature of teledermatology allows patient medical information (including history and visual data) obtained from one provider's location to be electronically transferred to a provider in another location (Roman & Jacob, 2015). The construct of the TeleDermViewPoint column is such that cases are presented in a standardized teledermatology reader format reflective of an actual teledermatology report.

HISTORY

Chief complaint: presenting for diagnosis of a lesion and therapeutic options.

History of Present Illness

An 85-year-old man presents with a long history of spots on his lower eyelids. His prior treatment: none. His primary symptoms: none. Prior biopsies: none.

IMAGE QUALITY ASSESSMENT

Fully satisfactory.

TELEDERMATOLOGY IMAGING READER REPORT1

There is one image provided with this consult. The image shows multiple small, grouped, smooth, skin-colored papules of 1-3 mm in diameter on the lower eyelid (see Figure 1).

FIGURE 1. The lower eyelid has multiple, grouped, skin-colored papules of 1-3 mm in diameter.

INTERPRETATION OF IMAGES

Lesion A

Findings

The history, distribution, and morphology of the lesions are characteristic of cutaneous syringoma.

RECOMMENDATIONS

Provide reassurance that it is a benign tumor derived from eccrine ducts. Any method of treatment carries the risk of dyspigmentation, scarring, erythema, and reoccurrence.

If the patient requested a cosmetic surgical option, current data suggest that the use of carbon dioxide laser ablation is the most efficacious treatment option with minimal side effects.

RECOMMENDED FOLLOW-UP

Type of Visit

Return to primary care for reassurance of the benign nature of the lesion is recommended.

CLINICAL PEARL

Syringoma is a benign adnexal tumor of eccrine duct origin that is commonly asymptomatic. Clinically, they appear as small, smooth-surfaced, soft, grouped, discrete, yellow or flesh-colored papules that are 1-3 mm in diameter. They most commonly appear in middle-aged women with localized infraocular involvement; however, many other clinical variants have been reported in the literature. Localized lesions can also appear on the genitalia and axillae (Cohen, Tschen, & Rapini, 2013; Nunez-Troconis & Viloria de Alvarado, 2015; Sakiyama, Maeda, Fujimoto, & Satoh, 2014; Young, Herman, & Tovell, 1980). Eruptive forms can occur on the anterior neck, chest, and abdomen and, in some cases, can have widespread involvement (Jamalipour, Heidarpour, & Rajabi, 2009; Naveen, Pai, Sori, Rai, & Rao, 2014; Soler-Carrillo, Estrach, & Mascaro, 2001). Friedman and Butler (1987) classified syringoma in four primary variants: a localized form, a familial form, a form associated with Down syndrome, and an eruptive form. In all forms, definitive diagnosis can only be verified by histologic examination.

Despite the benign nature of syringoma, it can be aesthetically displeasing and cause the patient significant psychosocial distress. Treatment options are limited to surgical therapies, which have inconsistent results and are restricted because of side effects. Carbon dioxide laser ablation is the most efficacious treatment. Modified forms of carbon dioxide laser ablation utilize the pinhole drilling method, botulinum toxin A, or radiofrequency (Hasson, Farias, Nicklas, & Navarrete, 2012; Lee et al., 2015; Seo, Choi, Min, & Kim, 2015). Other destructive therapy options with moderate results include photothermolysis, dermabrasion, and electrocoagulation (Akita et al., 2009; Al Aradi, 2006).

Medical therapeutic options have been reported in case studies with inconclusive results. Medications such as topical tretinoin, tranilast, and topical atropine have shown to provide some clinical benefit; however, larger studies must be conducted (Gomez, Perez, Azana, Nunez, & Ledo, 1994; Horie et al., 2012; Sanchez, Dauden, Casas, & Garcia-Diez, 2001).

REFERENCES