Answer to Image of the Month May 2014

Submitted by I S Reddy, Anuradha S


Sebaceous hyperplasia

A 42- year- old male presented with multiple, asymptomatic, skin coloured, discrete papules and some of them showing a central dell over both cheeks, nasolabial areas and forehead since 3 to 4 years. Clinically molluscum contagiosum, closed comedones of acne vulgaris and sebaceous hyperplasia were suspected.
Skin biopsy showed a well encapsulated lesion which consisted of a single, enlarged sebaceous gland with numerous lobules grouped around a centrally located, wide sebaceous duct. The central duct showed keratin debris.
The histological differential diagnosis is rhinophyma which shows large sebaceous glands and ducts but devoid of grouping of sebaceous lobules around the ducts. In elderly patients, early sebaceous carcinoma should be excluded, which is characterised by architectural atypia, increase in thickness of immature sebocytes at the periphery, crowding and mitoses.