Photo Rounds

Forehead growth

A 58-year-old man went to his family physician (FP) for a growth on his face that he’d had for 3 months. The growth was doughnut-shaped and pearly, with a few fine peripheral telangiectasias. The patient had no other symptoms but did admit to a lot of sun exposure.

What’s your diagnosis?


Based on the doughnut shape of the growth, and other similar-looking lesions on the patient’s face, the FP diagnosed sebaceous hyperplasia (SH).

SH is a common, benign condition of the sebaceous glands. It becomes more common on the face starting in middle age. The cells that form the sebaceous gland (sebocytes) accumulate lipid material as they migrate from the basal layer of the gland to the central duct, where they release the lipid content as sebum. In younger individuals, turnover of sebocytes occurs approximately every month. With aging, the sebocyte turnover slows down. This results in crowding of primitive sebocytes within the sebaceous gland, causing the benign hamartomatous enlargement known as SH. Fortunately, there is no known potential for malignant transformation.

SH is located on the face, particularly the cheeks, forehead and nose. (There are other variations of sebaceous hyperplasia found on the lips, areolas, and genitalia.) Single—or groups—of lesions appear as yellowish, soft, small papules ranging in size from 2 to 9 mm. Aging and genetics are the most common risk factors. A small amount of sebum can sometimes be expressed with gentle pressure.

Dermoscopy aids in distinguishing between SH and nodular basal cell carcinoma (BCC). SH has a pattern of crown vessels that extend toward the center of the lesion and do not cross the midline, whereas BCC has branching vessels that can be found randomly distributed throughout the lesion. A biopsy isn’t usually necessary, unless there are features suspicious for BCC. Options for removal include electrodesiccation, cryotherapy, laser treatment, photodynamic therapy, and shave excision. Electrodessication can be performed without anesthesia using a very low setting of an electrosurgical instrument.

The patient in this case wanted the SH removed, so a shave biopsy was performed to make sure this was not a BCC. Pathology confirmed SH and the cosmetic result was excellent.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Smith M. Sebaceous hyperplasia. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013: 931-934.

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