Spiradenoma Clinical Presentation

Updated: Dec 16, 2019
  • Author: Nikki A Levin, MD, PhD; Chief Editor: Dirk M Elston, MD  more...
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Presentation

History

In evaluating a patient for spiradenoma, it is helpful to gather information on number, location, pain, size, growth, age, timing, and family history. Spiradenoma lesions typically appear as solitary dermal nodules that arise on the head, neck, trunk, and, less commonly, the arms or legs. Lesions tend to be about 1 cm in diameter. They can remain stable in size or they can grow. They can be painful or asymptomatic and range in color. Brooke-Spiegler syndrome should be considered if a patient reports multiple lesions or a family history of similar tumors.

In the initial studies of spiradenoma, 91% of patients reported associated pain or tenderness. [15] However, a more recent study of 49 spiradenomas found pain or tenderness in only 23% of the 35 patients who had well-documented clinical histories. [16] Thus, spiradenomas may be painful, but it is not necessarily a defining characteristic.

Malignant spiradenoma can develop in long-standing lesions, [17] although malignant transformation overall is rare. A history of rapid growth, often associated with an ulceration and a change in color, is suggestive of malignant transformation.

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Physical Examination

Spiradenomas are usually flesh-colored, gray, pink, purple, red, or blue nodules about 1 cm in diameter. The lesions tend to occur on the scalp, neck, and upper part of the torso. Spiradenomas tend to be soft and are sometimes tender to palpation.

More rare locations for spiradenoma have been reported, including in the ears, external auditory canals, eyelid, proximal nail fold, and vulva. [18, 19, 20, 21, 22, 23, 24] Giant eccrine spiradenoma of the hand has been reported. [25]

Malignant spiradenomas tend to have slightly different features than benign spiradenomas based on size, appearance, and location. They tend to be larger than benign spiradenomas, with a median diameter at presentation of 3 cm (range, 0.8-25 cm). Malignant spiradenomas also tend to ulcerate. Whereas some studies suggest malignant spiradenomas preferentially involve the trunk and the extremities, more recent literature reviews do not support any location predominance. [12] Other documented cases of spiradenoma have involved the scalp, [26, 27, 28] vulva, [29, 30] toes, [31] and a traumatized area. [32]

Malignant spiradenomas can metastasize. A review of spiradenocarcinomas found a 19% rate of metastasis, with the most common sites being lung, bone, and lymph nodes. Less frequent locations of metastases were liver, kidney, and breast. [12] Thus, it is important to evaluate for potential metastatic disease on physical examination.

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Complications

Long-standing lesions of spiradenoma can turn into malignant spiradenoma. Thus, changing skin tumors should prompt evaluation. Malignant spiradenoma can metastasize.

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