Rare case presentation of dozens of facial hidrocystomas confirmed by histopathology

Summary: Hidrocystomas are rare, benign cystic tumors of either eccrine or apocrine gland epithelium. The eccrine form may appear as solitary or multiple adenomatous papules or nodules, and are commonly found periocularly, in the scalp, and around the neck. ​These lesions have size ranges from 1-15 mm, the smaller lesions are typically of eccrine origin, and they are translucent with palpable mobility. Our patient is a 52-year-old woman who presented to outpatient Dermatology clinic with over 2 dozen blue-black macules across the nose and bilateral cheeks in the absence of palpability, erythema or crusting. Histopathologic evaluation of a punch biopsy of the chin revealed a large unilocular cystic space within the dermis filled with gelatinous material, containing a thin and fibrous pseudocapsule, consistent with atypical eccrine hidrocystoma histology. Final pathology significantly supported the diagnosis of the atypical presentation of hidrocystomas. Our patient experienced resolve with the chin solitary hidrocystoma after punch biopsy with no evidence of recurrence at the six-month follow-up visit. However, due to her presentation of dozens of hidrocystomas, excisional biopsies were not a reasonable therapeutic option.