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.

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.

Complications

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

Differential Diagnoses

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Media Gallery

Spiradenoma. Vascular channels within a basaloid tumor. Courtesy of Sarahkayb (own work), via Wikimedia Commons.

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Author

Nikki A Levin, MD, PhD Associate Professor of Medicine, Division of Dermatology, University of Massachusetts Medical School

Nikki A Levin, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Phi Beta Kappa, Sigma Xi, The Scientific Research Honor Society, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Holly D Neale, BS MD Candidate, University of Massachusetts Medical School

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American College of Rheumatology

Disclosure: Received income in an amount equal to or greater than $250 from: Biogen US (Adjudicator for study entry cutaneous lupus erythematosus); Priovant (Adjudicator for entry into a dermatomyositis study); IQVIA (Serono - adjudicator for a study of cutaneous LE) <br/>Received honoraria from UpToDate for author/editor; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for these trust accounts for: Stocks held in various trust accounts: Allergen; Amgen; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble;; Celgene; Gilead; CVS; Walgreens; Bristol-Myers Squibb.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Noah S Scheinfeld, JD, MD, FAAD † Assistant Clinical Professor, Department of Dermatology, Weil Cornell Medical College; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Assistant Attending Dermatologist, New York Presbyterian Hospital; Assistant Attending Dermatologist, Lenox Hill Hospital, North Shore-LIJ Health System; Private Practice

Noah S Scheinfeld, JD, MD, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Spiradenoma Clinical Presentation

History

Physical Examination

Complications

References

Tables

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