A 51-year-old Caucasian man presented with asymptomatic lesions on his breasts of several years’ duration. Cutaneous examination revealed individual and confluent white-yellow dermal papules and plaques involving the areola and nipple bilaterally (Figures 1A and B).
WHAT IS YOUR DIAGNOSIS?
To learn the answer, go to page 2
{{pagebreak}}
Diagnosis: Ectopic Sebaceous Glands
Sebaceous glands are exocrine glands in the skin that secrete sebum, a waxy lipid with antimicrobial properties.1 Sebaceous glands exist in 2 forms. Most commonly, they are found in association with hair follicles as pilosebaceous units. However, sebaceous glands may also develop in the absence of a hair follicle; these glands, known as ectopic sebaceous glands, are either not associated with a hair follicle or are connected only to the infundibulum of a follicle.
Ectopic sebaceous glands occur in approximately 80% of the adult population.2,3 They appear most frequently on the vermilion border of the lips, the genital mucosa and the buccal mucosa; in this setting, the lesions are referred to as Fordyce spots.4 Ectopic sebaceous glands that are found on the areola are known as Montgomery tubercles5; those appearing on the male prepuce and/or glans penis are called Tyson glands.6 Interestingly, despite the fact that sebaceous glands are ectodermally derived, ectopic sebaceous glands have been observed within endodermal structures, such as the esophagus and thymus.7,8 Ectopic sebaceous glands in the orbit, tongue and uterine cervix have also been described.9-11
Clinical Presentation
Ectopic sebaceous glands are essentially normal sebaceous glands appearing at non-hair-bearing locations. They present as 1 to 3 mm lesions and may appear at various sites (Table).8 Our patient’s ectopic sebaceous glands were not only present on the areola and nipple of his breasts (Figures 1 and 2), but also on his upper and lower lips (Figure 3).
Often, the diagnosis of ectopic sebaceous glands is based on clinical features. A biopsy may be performed to confirm the suspected diagnosis and/or exclude alternative diagnoses.
Histopathology
Ectopic sebaceous glands are histologically identical to follicle-associated sebaceous glands. They appear as lobules of mature sebocytes. In the ectopic setting, the glands usually open directly into the epidermis instead of a hair follicle. However, in some patients, ectopic sebaceous glands may connect to the infundibulum of a hair follicle (Figures 4A-C).
Pathogenesis
The pathogenesis of ectopic sebaceous glands is unknown. Between the fourth and eighth week of life, sebaceous glands develop independently of hair follicles in the meibomian glands of the eyelids, the perianal region and the skin of the palms and soles.8 However, the origin of ectopic sebaceous glands outside of these regions is yet to be determined.
Differential Diagnosis
The differential diagnosis of ectopic sebaceous glands is based primarily on location. On the penis, ectopic sebaceous glands can mimic other small papillary lesions, solitary or in aggregate: angiofibroma, condyloma and sebaceous adenoma. On the breast, the differential diagnosis for ectopic sebaceous glands includes adenoma, hyperplastic mammary glands and leiomyoma. On the lips, ectopic sebaceous glands may appear similar to leukoplakia.
Treatment
Ectopic sebaceous glands are benign. Often, the lesions have been present for several years. Many individuals are satisfied with reassurance. If desired, treatment considerations could be similar to those of sebaceous hyperplasia, including electrodesiccation or laser ablation of the lesions.12-14
Our Patient
A biopsy was performed to confirm the clinically suspected diagnosis (Figures 4A-C). The specimen revealed multiple mature-appearing sebaceous glands opening directly into the epidermis; some of the glands were associated with a 
lymphoplasmacytic inflammation. Correlation of the clinical presentation and histology findings established the diagnosis of ectopic sebaceous glands. After the patient was reassured of the benign nature of the condition, he did not request any additional treatment.
Conclusion
Ectopic sebaceous glands are benign lesions that occur when normal sebaceous glands develop without association to a hair follicle. They typically present as 1 to 3 mm white or yellow-white dermal papules; confluent individual lesions may present as dermal plaques. Ectopic sebaceous glands may appear at various sites on the body, but are most commonly found on the lips, buccal mucosa and genital mucosa. Lesions found on the areola are referred to as Montgomery tubercles and those found on the penis are called Tyson glands.
The diagnosis of ectopic sebaceous glands is based primarily on lesion morphology. A confirmatory biopsy is not usually necessary, but can be performed in order to exclude alternative diagnoses. Ectopic sebaceous glands are asymptomatic and do not have any adverse associated sequelae. Therefore, reassurance of the benign nature of the condition is a reasonable alternative to management. If the patient is concerned about the cosmetic features of ectopic sebaceous glands, ablation using electrodesiccation or laser may provide a potential therapeutic alternative.
Mr. Beutler is with the University of Nevada School of Medicine in Reno, NV.
Dr. Cohen, is with the department of dermatology at the University of California San Diego in San Diego, CA.
Disclosure: The authors report no relevant financial relationships.
References
1. Zouboulis CC, Baron JM, Bohm M, et al. Frontiers in sebaceous gland biology and pathology. Exp Dermatol. 2008;17(6):542-551.
2. Scully C. Common complaints. In: Oral and Maxillofacial Medicine: The Basis of Diagnosis and Treatment. 3rd ed. Edinburgh, Scotland: Churchill Livingstone; 2013:170.
3. Halperin V, Kolas S, Jefferis KR, Huddleston SO, Robinson HB. The occurrence of Fordyce spots, benign migratory glossitis, median rhomboid glossitis, and fissured tongue in 2,478 dental patients. Oral Surg Oral Med Oral Pathol. 1953;6(9):1072-1077.
4. Olivier JH. Fordyce granules on the prolabial and oral mucous membranes of a selected population. SADJ. 2006;61(2):72-74.
5. Ackerman AB, Penneys NS. Montgomery’s tubercles. Sebaceous glands. Obstet Gynecol. 1971;38(6):924-927.
6. Batistatou A, Panelos J, Zioga A, Charalabopoulos KA. Ectopic modified sebaceous glands in human penis. Int J Surg Pathol. 2006;14(4):355-356.
7. Bertoni G, Sassatelli R, Nigrisoli E, Conigliaro R, Bedogni G. Ectopic sebaceous glands in the esophagus: report of three new cases and review of the literature. Am J Gastroenterol. 1994;89(10):1884-1887.
8. Wolff M, Rosai J, Wright DH. Sebaceous glands within the thymus: report of three cases. Hum Pathol. 1984;15(4):341-343.
9. Guiducci AA, Hyman AB. Ectopic sebaceous glands. A review of the literature regarding their occurrence, histology and embryonic relationships. Dermatologica. 1962;125:44-63.
10. Trodahl JN, Albjerg LE, Gorlin RJ. Ectopic sebaceous glands of the tongue. Arch Dermatol.1967;95(4):387-389.
11. Kazakov DV, Hejda V, Kacerovska D, Michal M. Hyperplasia of ectopic sebaceous glands in the uterine cervix: case report. Int J Gynecol Pathol. 2010;29(6):605-608.
12. Chern PL, Arpey CJ. Fordyce spots of the lip responding to electrodesiccation and curettage. Dermatol Surg. 2008;34(7):960-962.
13. Ocampo-Candiani J, Villarreal-Rodriguez A, Quiñones-Fernandez AG, Herz-Ruelas ME, Ruiz-Esparza J. Treatment of Fordyce spots with CO2 laser. Dermatol Surg. 2003;29(8):869-871.
14. Baeder FM, Pelino JE, de Almeida ER, Duarte DA, Santos MT. High-power diode laser use on Fordyce granule excision: a case report. J Cosmet Dermatol. 2010;9(4):321-324.
A 51-year-old Caucasian man presented with asymptomatic lesions on his breasts of several years’ duration. Cutaneous examination revealed individual and confluent white-yellow dermal papules and plaques involving the areola and nipple bilaterally (Figures 1A and B).
WHAT IS YOUR DIAGNOSIS?
Diagnosis: Ectopic Sebaceous Glands
Sebaceous glands are exocrine glands in the skin that secrete sebum, a waxy lipid with antimicrobial properties.1 Sebaceous glands exist in 2 forms. Most commonly, they are found in association with hair follicles as pilosebaceous units. However, sebaceous glands may also develop in the absence of a hair follicle; these glands, known as ectopic sebaceous glands, are either not associated with a hair follicle or are connected only to the infundibulum of a follicle.
Ectopic sebaceous glands occur in approximately 80% of the adult population.2,3 They appear most frequently on the vermilion border of the lips, the genital mucosa and the buccal mucosa; in this setting, the lesions are referred to as Fordyce spots.4 Ectopic sebaceous glands that are found on the areola are known as Montgomery tubercles5; those appearing on the male prepuce and/or glans penis are called Tyson glands.6 Interestingly, despite the fact that sebaceous glands are ectodermally derived, ectopic sebaceous glands have been observed within endodermal structures, such as the esophagus and thymus.7,8 Ectopic sebaceous glands in the orbit, tongue and uterine cervix have also been described.9-11
Clinical Presentation
Ectopic sebaceous glands are essentially normal sebaceous glands appearing at non-hair-bearing locations. They present as 1 to 3 mm lesions and may appear at various sites (Table).8 Our patient’s ectopic sebaceous glands were not only present on the areola and nipple of his breasts (Figures 1 and 2), but also on his upper and lower lips (Figure 3).
Often, the diagnosis of ectopic sebaceous glands is based on clinical features. A biopsy may be performed to confirm the suspected diagnosis and/or exclude alternative diagnoses.
Histopathology
Ectopic sebaceous glands are histologically identical to follicle-associated sebaceous glands. They appear as lobules of mature sebocytes. In the ectopic setting, the glands usually open directly into the epidermis instead of a hair follicle. However, in some patients, ectopic sebaceous glands may connect to the infundibulum of a hair follicle (Figures 4A-C).
Pathogenesis
The pathogenesis of ectopic sebaceous glands is unknown. Between the fourth and eighth week of life, sebaceous glands develop independently of hair follicles in the meibomian glands of the eyelids, the perianal region and the skin of the palms and soles.8 However, the origin of ectopic sebaceous glands outside of these regions is yet to be determined.
Differential Diagnosis
The differential diagnosis of ectopic sebaceous glands is based primarily on location. On the penis, ectopic sebaceous glands can mimic other small papillary lesions, solitary or in aggregate: angiofibroma, condyloma and sebaceous adenoma. On the breast, the differential diagnosis for ectopic sebaceous glands includes adenoma, hyperplastic mammary glands and leiomyoma. On the lips, ectopic sebaceous glands may appear similar to leukoplakia.
Treatment
Ectopic sebaceous glands are benign. Often, the lesions have been present for several years. Many individuals are satisfied with reassurance. If desired, treatment considerations could be similar to those of sebaceous hyperplasia, including electrodesiccation or laser ablation of the lesions.12-14
Our Patient
A biopsy was performed to confirm the clinically suspected diagnosis (Figures 4A-C). The specimen revealed multiple mature-appearing sebaceous glands opening directly into the epidermis; some of the glands were associated with a 
lymphoplasmacytic inflammation. Correlation of the clinical presentation and histology findings established the diagnosis of ectopic sebaceous glands. After the patient was reassured of the benign nature of the condition, he did not request any additional treatment.
Conclusion
Ectopic sebaceous glands are benign lesions that occur when normal sebaceous glands develop without association to a hair follicle. They typically present as 1 to 3 mm white or yellow-white dermal papules; confluent individual lesions may present as dermal plaques. Ectopic sebaceous glands may appear at various sites on the body, but are most commonly found on the lips, buccal mucosa and genital mucosa. Lesions found on the areola are referred to as Montgomery tubercles and those found on the penis are called Tyson glands.
The diagnosis of ectopic sebaceous glands is based primarily on lesion morphology. A confirmatory biopsy is not usually necessary, but can be performed in order to exclude alternative diagnoses. Ectopic sebaceous glands are asymptomatic and do not have any adverse associated sequelae. Therefore, reassurance of the benign nature of the condition is a reasonable alternative to management. If the patient is concerned about the cosmetic features of ectopic sebaceous glands, ablation using electrodesiccation or laser may provide a potential therapeutic alternative.
Mr. Beutler is with the University of Nevada School of Medicine in Reno, NV.
Dr. Cohen, is with the department of dermatology at the University of California San Diego in San Diego, CA.
Disclosure: The authors report no relevant financial relationships.
References
1. Zouboulis CC, Baron JM, Bohm M, et al. Frontiers in sebaceous gland biology and pathology. Exp Dermatol. 2008;17(6):542-551.
2. Scully C. Common complaints. In: Oral and Maxillofacial Medicine: The Basis of Diagnosis and Treatment. 3rd ed. Edinburgh, Scotland: Churchill Livingstone; 2013:170.
3. Halperin V, Kolas S, Jefferis KR, Huddleston SO, Robinson HB. The occurrence of Fordyce spots, benign migratory glossitis, median rhomboid glossitis, and fissured tongue in 2,478 dental patients. Oral Surg Oral Med Oral Pathol. 1953;6(9):1072-1077.
4. Olivier JH. Fordyce granules on the prolabial and oral mucous membranes of a selected population. SADJ. 2006;61(2):72-74.
5. Ackerman AB, Penneys NS. Montgomery’s tubercles. Sebaceous glands. Obstet Gynecol. 1971;38(6):924-927.
6. Batistatou A, Panelos J, Zioga A, Charalabopoulos KA. Ectopic modified sebaceous glands in human penis. Int J Surg Pathol. 2006;14(4):355-356.
7. Bertoni G, Sassatelli R, Nigrisoli E, Conigliaro R, Bedogni G. Ectopic sebaceous glands in the esophagus: report of three new cases and review of the literature. Am J Gastroenterol. 1994;89(10):1884-1887.
8. Wolff M, Rosai J, Wright DH. Sebaceous glands within the thymus: report of three cases. Hum Pathol. 1984;15(4):341-343.
9. Guiducci AA, Hyman AB. Ectopic sebaceous glands. A review of the literature regarding their occurrence, histology and embryonic relationships. Dermatologica. 1962;125:44-63.
10. Trodahl JN, Albjerg LE, Gorlin RJ. Ectopic sebaceous glands of the tongue. Arch Dermatol.1967;95(4):387-389.
11. Kazakov DV, Hejda V, Kacerovska D, Michal M. Hyperplasia of ectopic sebaceous glands in the uterine cervix: case report. Int J Gynecol Pathol. 2010;29(6):605-608.
12. Chern PL, Arpey CJ. Fordyce spots of the lip responding to electrodesiccation and curettage. Dermatol Surg. 2008;34(7):960-962.
13. Ocampo-Candiani J, Villarreal-Rodriguez A, Quiñones-Fernandez AG, Herz-Ruelas ME, Ruiz-Esparza J. Treatment of Fordyce spots with CO2 laser. Dermatol Surg. 2003;29(8):869-871.
14. Baeder FM, Pelino JE, de Almeida ER, Duarte DA, Santos MT. High-power diode laser use on Fordyce granule excision: a case report. J Cosmet Dermatol. 2010;9(4):321-324.
A 51-year-old Caucasian man presented with asymptomatic lesions on his breasts of several years’ duration. Cutaneous examination revealed individual and confluent white-yellow dermal papules and plaques involving the areola and nipple bilaterally (Figures 1A and B).
WHAT IS YOUR DIAGNOSIS?
A 51-year-old Caucasian man presented with asymptomatic lesions on his breasts of several years’ duration. Cutaneous examination revealed individual and confluent white-yellow dermal papules and plaques involving the areola and nipple bilaterally (Figures 1A and B).
WHAT IS YOUR DIAGNOSIS?
To learn the answer, go to page 2
{{pagebreak}}
Diagnosis: Ectopic Sebaceous Glands
Sebaceous glands are exocrine glands in the skin that secrete sebum, a waxy lipid with antimicrobial properties.1 Sebaceous glands exist in 2 forms. Most commonly, they are found in association with hair follicles as pilosebaceous units. However, sebaceous glands may also develop in the absence of a hair follicle; these glands, known as ectopic sebaceous glands, are either not associated with a hair follicle or are connected only to the infundibulum of a follicle.
Ectopic sebaceous glands occur in approximately 80% of the adult population.2,3 They appear most frequently on the vermilion border of the lips, the genital mucosa and the buccal mucosa; in this setting, the lesions are referred to as Fordyce spots.4 Ectopic sebaceous glands that are found on the areola are known as Montgomery tubercles5; those appearing on the male prepuce and/or glans penis are called Tyson glands.6 Interestingly, despite the fact that sebaceous glands are ectodermally derived, ectopic sebaceous glands have been observed within endodermal structures, such as the esophagus and thymus.7,8 Ectopic sebaceous glands in the orbit, tongue and uterine cervix have also been described.9-11
Clinical Presentation
Ectopic sebaceous glands are essentially normal sebaceous glands appearing at non-hair-bearing locations. They present as 1 to 3 mm lesions and may appear at various sites (Table).8 Our patient’s ectopic sebaceous glands were not only present on the areola and nipple of his breasts (Figures 1 and 2), but also on his upper and lower lips (Figure 3).
Often, the diagnosis of ectopic sebaceous glands is based on clinical features. A biopsy may be performed to confirm the suspected diagnosis and/or exclude alternative diagnoses.
Histopathology
Ectopic sebaceous glands are histologically identical to follicle-associated sebaceous glands. They appear as lobules of mature sebocytes. In the ectopic setting, the glands usually open directly into the epidermis instead of a hair follicle. However, in some patients, ectopic sebaceous glands may connect to the infundibulum of a hair follicle (Figures 4A-C).
Pathogenesis
The pathogenesis of ectopic sebaceous glands is unknown. Between the fourth and eighth week of life, sebaceous glands develop independently of hair follicles in the meibomian glands of the eyelids, the perianal region and the skin of the palms and soles.8 However, the origin of ectopic sebaceous glands outside of these regions is yet to be determined.
Differential Diagnosis
The differential diagnosis of ectopic sebaceous glands is based primarily on location. On the penis, ectopic sebaceous glands can mimic other small papillary lesions, solitary or in aggregate: angiofibroma, condyloma and sebaceous adenoma. On the breast, the differential diagnosis for ectopic sebaceous glands includes adenoma, hyperplastic mammary glands and leiomyoma. On the lips, ectopic sebaceous glands may appear similar to leukoplakia.
Treatment
Ectopic sebaceous glands are benign. Often, the lesions have been present for several years. Many individuals are satisfied with reassurance. If desired, treatment considerations could be similar to those of sebaceous hyperplasia, including electrodesiccation or laser ablation of the lesions.12-14
Our Patient
A biopsy was performed to confirm the clinically suspected diagnosis (Figures 4A-C). The specimen revealed multiple mature-appearing sebaceous glands opening directly into the epidermis; some of the glands were associated with a lymphoplasmacytic inflammation. Correlation of the clinical presentation and histology findings established the diagnosis of ectopic sebaceous glands. After the patient was reassured of the benign nature of the condition, he did not request any additional treatment.
Conclusion
Ectopic sebaceous glands are benign lesions that occur when normal sebaceous glands develop without association to a hair follicle. They typically present as 1 to 3 mm white or yellow-white dermal papules; confluent individual lesions may present as dermal plaques. Ectopic sebaceous glands may appear at various sites on the body, but are most commonly found on the lips, buccal mucosa and genital mucosa. Lesions found on the areola are referred to as Montgomery tubercles and those found on the penis are called Tyson glands.
The diagnosis of ectopic sebaceous glands is based primarily on lesion morphology. A confirmatory biopsy is not usually necessary, but can be performed in order to exclude alternative diagnoses. Ectopic sebaceous glands are asymptomatic and do not have any adverse associated sequelae. Therefore, reassurance of the benign nature of the condition is a reasonable alternative to management. If the patient is concerned about the cosmetic features of ectopic sebaceous glands, ablation using electrodesiccation or laser may provide a potential therapeutic alternative.
Mr. Beutler is with the University of Nevada School of Medicine in Reno, NV.
Dr. Cohen, is with the department of dermatology at the University of California San Diego in San Diego, CA.
Disclosure: The authors report no relevant financial relationships.
References
1. Zouboulis CC, Baron JM, Bohm M, et al. Frontiers in sebaceous gland biology and pathology. Exp Dermatol. 2008;17(6):542-551.
2. Scully C. Common complaints. In: Oral and Maxillofacial Medicine: The Basis of Diagnosis and Treatment. 3rd ed. Edinburgh, Scotland: Churchill Livingstone; 2013:170.
3. Halperin V, Kolas S, Jefferis KR, Huddleston SO, Robinson HB. The occurrence of Fordyce spots, benign migratory glossitis, median rhomboid glossitis, and fissured tongue in 2,478 dental patients. Oral Surg Oral Med Oral Pathol. 1953;6(9):1072-1077.
4. Olivier JH. Fordyce granules on the prolabial and oral mucous membranes of a selected population. SADJ. 2006;61(2):72-74.
5. Ackerman AB, Penneys NS. Montgomery’s tubercles. Sebaceous glands. Obstet Gynecol. 1971;38(6):924-927.
6. Batistatou A, Panelos J, Zioga A, Charalabopoulos KA. Ectopic modified sebaceous glands in human penis. Int J Surg Pathol. 2006;14(4):355-356.
7. Bertoni G, Sassatelli R, Nigrisoli E, Conigliaro R, Bedogni G. Ectopic sebaceous glands in the esophagus: report of three new cases and review of the literature. Am J Gastroenterol. 1994;89(10):1884-1887.
8. Wolff M, Rosai J, Wright DH. Sebaceous glands within the thymus: report of three cases. Hum Pathol. 1984;15(4):341-343.
9. Guiducci AA, Hyman AB. Ectopic sebaceous glands. A review of the literature regarding their occurrence, histology and embryonic relationships. Dermatologica. 1962;125:44-63.
10. Trodahl JN, Albjerg LE, Gorlin RJ. Ectopic sebaceous glands of the tongue. Arch Dermatol.1967;95(4):387-389.
11. Kazakov DV, Hejda V, Kacerovska D, Michal M. Hyperplasia of ectopic sebaceous glands in the uterine cervix: case report. Int J Gynecol Pathol. 2010;29(6):605-608.
12. Chern PL, Arpey CJ. Fordyce spots of the lip responding to electrodesiccation and curettage. Dermatol Surg. 2008;34(7):960-962.
13. Ocampo-Candiani J, Villarreal-Rodriguez A, Quiñones-Fernandez AG, Herz-Ruelas ME, Ruiz-Esparza J. Treatment of Fordyce spots with CO2 laser. Dermatol Surg. 2003;29(8):869-871.
14. Baeder FM, Pelino JE, de Almeida ER, Duarte DA, Santos MT. High-power diode laser use on Fordyce granule excision: a case report. J Cosmet Dermatol. 2010;9(4):321-324.
A 51-year-old Caucasian man presented with asymptomatic lesions on his breasts of several years’ duration. Cutaneous examination revealed individual and confluent white-yellow dermal papules and plaques involving the areola and nipple bilaterally (Figures 1A and B).
WHAT IS YOUR DIAGNOSIS?
Diagnosis: Ectopic Sebaceous Glands
Sebaceous glands are exocrine glands in the skin that secrete sebum, a waxy lipid with antimicrobial properties.1 Sebaceous glands exist in 2 forms. Most commonly, they are found in association with hair follicles as pilosebaceous units. However, sebaceous glands may also develop in the absence of a hair follicle; these glands, known as ectopic sebaceous glands, are either not associated with a hair follicle or are connected only to the infundibulum of a follicle.
Ectopic sebaceous glands occur in approximately 80% of the adult population.2,3 They appear most frequently on the vermilion border of the lips, the genital mucosa and the buccal mucosa; in this setting, the lesions are referred to as Fordyce spots.4 Ectopic sebaceous glands that are found on the areola are known as Montgomery tubercles5; those appearing on the male prepuce and/or glans penis are called Tyson glands.6 Interestingly, despite the fact that sebaceous glands are ectodermally derived, ectopic sebaceous glands have been observed within endodermal structures, such as the esophagus and thymus.7,8 Ectopic sebaceous glands in the orbit, tongue and uterine cervix have also been described.9-11
Clinical Presentation
Ectopic sebaceous glands are essentially normal sebaceous glands appearing at non-hair-bearing locations. They present as 1 to 3 mm lesions and may appear at various sites (Table).8 Our patient’s ectopic sebaceous glands were not only present on the areola and nipple of his breasts (Figures 1 and 2), but also on his upper and lower lips (Figure 3).
Often, the diagnosis of ectopic sebaceous glands is based on clinical features. A biopsy may be performed to confirm the suspected diagnosis and/or exclude alternative diagnoses.
Histopathology
Ectopic sebaceous glands are histologically identical to follicle-associated sebaceous glands. They appear as lobules of mature sebocytes. In the ectopic setting, the glands usually open directly into the epidermis instead of a hair follicle. However, in some patients, ectopic sebaceous glands may connect to the infundibulum of a hair follicle (Figures 4A-C).
Pathogenesis
The pathogenesis of ectopic sebaceous glands is unknown. Between the fourth and eighth week of life, sebaceous glands develop independently of hair follicles in the meibomian glands of the eyelids, the perianal region and the skin of the palms and soles.8 However, the origin of ectopic sebaceous glands outside of these regions is yet to be determined.
Differential Diagnosis
The differential diagnosis of ectopic sebaceous glands is based primarily on location. On the penis, ectopic sebaceous glands can mimic other small papillary lesions, solitary or in aggregate: angiofibroma, condyloma and sebaceous adenoma. On the breast, the differential diagnosis for ectopic sebaceous glands includes adenoma, hyperplastic mammary glands and leiomyoma. On the lips, ectopic sebaceous glands may appear similar to leukoplakia.
Treatment
Ectopic sebaceous glands are benign. Often, the lesions have been present for several years. Many individuals are satisfied with reassurance. If desired, treatment considerations could be similar to those of sebaceous hyperplasia, including electrodesiccation or laser ablation of the lesions.12-14
Our Patient
A biopsy was performed to confirm the clinically suspected diagnosis (Figures 4A-C). The specimen revealed multiple mature-appearing sebaceous glands opening directly into the epidermis; some of the glands were associated with a lymphoplasmacytic inflammation. Correlation of the clinical presentation and histology findings established the diagnosis of ectopic sebaceous glands. After the patient was reassured of the benign nature of the condition, he did not request any additional treatment.
Conclusion
Ectopic sebaceous glands are benign lesions that occur when normal sebaceous glands develop without association to a hair follicle. They typically present as 1 to 3 mm white or yellow-white dermal papules; confluent individual lesions may present as dermal plaques. Ectopic sebaceous glands may appear at various sites on the body, but are most commonly found on the lips, buccal mucosa and genital mucosa. Lesions found on the areola are referred to as Montgomery tubercles and those found on the penis are called Tyson glands.
The diagnosis of ectopic sebaceous glands is based primarily on lesion morphology. A confirmatory biopsy is not usually necessary, but can be performed in order to exclude alternative diagnoses. Ectopic sebaceous glands are asymptomatic and do not have any adverse associated sequelae. Therefore, reassurance of the benign nature of the condition is a reasonable alternative to management. If the patient is concerned about the cosmetic features of ectopic sebaceous glands, ablation using electrodesiccation or laser may provide a potential therapeutic alternative.
Mr. Beutler is with the University of Nevada School of Medicine in Reno, NV.
Dr. Cohen, is with the department of dermatology at the University of California San Diego in San Diego, CA.
Disclosure: The authors report no relevant financial relationships.
References
1. Zouboulis CC, Baron JM, Bohm M, et al. Frontiers in sebaceous gland biology and pathology. Exp Dermatol. 2008;17(6):542-551.
2. Scully C. Common complaints. In: Oral and Maxillofacial Medicine: The Basis of Diagnosis and Treatment. 3rd ed. Edinburgh, Scotland: Churchill Livingstone; 2013:170.
3. Halperin V, Kolas S, Jefferis KR, Huddleston SO, Robinson HB. The occurrence of Fordyce spots, benign migratory glossitis, median rhomboid glossitis, and fissured tongue in 2,478 dental patients. Oral Surg Oral Med Oral Pathol. 1953;6(9):1072-1077.
4. Olivier JH. Fordyce granules on the prolabial and oral mucous membranes of a selected population. SADJ. 2006;61(2):72-74.
5. Ackerman AB, Penneys NS. Montgomery’s tubercles. Sebaceous glands. Obstet Gynecol. 1971;38(6):924-927.
6. Batistatou A, Panelos J, Zioga A, Charalabopoulos KA. Ectopic modified sebaceous glands in human penis. Int J Surg Pathol. 2006;14(4):355-356.
7. Bertoni G, Sassatelli R, Nigrisoli E, Conigliaro R, Bedogni G. Ectopic sebaceous glands in the esophagus: report of three new cases and review of the literature. Am J Gastroenterol. 1994;89(10):1884-1887.
8. Wolff M, Rosai J, Wright DH. Sebaceous glands within the thymus: report of three cases. Hum Pathol. 1984;15(4):341-343.
9. Guiducci AA, Hyman AB. Ectopic sebaceous glands. A review of the literature regarding their occurrence, histology and embryonic relationships. Dermatologica. 1962;125:44-63.
10. Trodahl JN, Albjerg LE, Gorlin RJ. Ectopic sebaceous glands of the tongue. Arch Dermatol.1967;95(4):387-389.
11. Kazakov DV, Hejda V, Kacerovska D, Michal M. Hyperplasia of ectopic sebaceous glands in the uterine cervix: case report. Int J Gynecol Pathol. 2010;29(6):605-608.
12. Chern PL, Arpey CJ. Fordyce spots of the lip responding to electrodesiccation and curettage. Dermatol Surg. 2008;34(7):960-962.
13. Ocampo-Candiani J, Villarreal-Rodriguez A, Quiñones-Fernandez AG, Herz-Ruelas ME, Ruiz-Esparza J. Treatment of Fordyce spots with CO2 laser. Dermatol Surg. 2003;29(8):869-871.
14. Baeder FM, Pelino JE, de Almeida ER, Duarte DA, Santos MT. High-power diode laser use on Fordyce granule excision: a case report. J Cosmet Dermatol. 2010;9(4):321-324.
Diagnosis: Ectopic Sebaceous Glands
Sebaceous glands are exocrine glands in the skin that secrete sebum, a waxy lipid with antimicrobial properties.1 Sebaceous glands exist in 2 forms. Most commonly, they are found in association with hair follicles as pilosebaceous units. However, sebaceous glands may also develop in the absence of a hair follicle; these glands, known as ectopic sebaceous glands, are either not associated with a hair follicle or are connected only to the infundibulum of a follicle.
Ectopic sebaceous glands occur in approximately 80% of the adult population.2,3 They appear most frequently on the vermilion border of the lips, the genital mucosa and the buccal mucosa; in this setting, the lesions are referred to as Fordyce spots.4 Ectopic sebaceous glands that are found on the areola are known as Montgomery tubercles5; those appearing on the male prepuce and/or glans penis are called Tyson glands.6 Interestingly, despite the fact that sebaceous glands are ectodermally derived, ectopic sebaceous glands have been observed within endodermal structures, such as the esophagus and thymus.7,8 Ectopic sebaceous glands in the orbit, tongue and uterine cervix have also been described.9-11
Clinical Presentation
Ectopic sebaceous glands are essentially normal sebaceous glands appearing at non-hair-bearing locations. They present as 1 to 3 mm lesions and may appear at various sites (Table).8 Our patient’s ectopic sebaceous glands were not only present on the areola and nipple of his breasts (Figures 1 and 2), but also on his upper and lower lips (Figure 3).
Often, the diagnosis of ectopic sebaceous glands is based on clinical features. A biopsy may be performed to confirm the suspected diagnosis and/or exclude alternative diagnoses.
Histopathology
Ectopic sebaceous glands are histologically identical to follicle-associated sebaceous glands. They appear as lobules of mature sebocytes. In the ectopic setting, the glands usually open directly into the epidermis instead of a hair follicle. However, in some patients, ectopic sebaceous glands may connect to the infundibulum of a hair follicle (Figures 4A-C).
Pathogenesis
The pathogenesis of ectopic sebaceous glands is unknown. Between the fourth and eighth week of life, sebaceous glands develop independently of hair follicles in the meibomian glands of the eyelids, the perianal region and the skin of the palms and soles.8 However, the origin of ectopic sebaceous glands outside of these regions is yet to be determined.
Differential Diagnosis
The differential diagnosis of ectopic sebaceous glands is based primarily on location. On the penis, ectopic sebaceous glands can mimic other small papillary lesions, solitary or in aggregate: angiofibroma, condyloma and sebaceous adenoma. On the breast, the differential diagnosis for ectopic sebaceous glands includes adenoma, hyperplastic mammary glands and leiomyoma. On the lips, ectopic sebaceous glands may appear similar to leukoplakia.
Treatment
Ectopic sebaceous glands are benign. Often, the lesions have been present for several years. Many individuals are satisfied with reassurance. If desired, treatment considerations could be similar to those of sebaceous hyperplasia, including electrodesiccation or laser ablation of the lesions.12-14
Our Patient
A biopsy was performed to confirm the clinically suspected diagnosis (Figures 4A-C). The specimen revealed multiple mature-appearing sebaceous glands opening directly into the epidermis; some of the glands were associated with a lymphoplasmacytic inflammation. Correlation of the clinical presentation and histology findings established the diagnosis of ectopic sebaceous glands. After the patient was reassured of the benign nature of the condition, he did not request any additional treatment.
Conclusion
Ectopic sebaceous glands are benign lesions that occur when normal sebaceous glands develop without association to a hair follicle. They typically present as 1 to 3 mm white or yellow-white dermal papules; confluent individual lesions may present as dermal plaques. Ectopic sebaceous glands may appear at various sites on the body, but are most commonly found on the lips, buccal mucosa and genital mucosa. Lesions found on the areola are referred to as Montgomery tubercles and those found on the penis are called Tyson glands.
The diagnosis of ectopic sebaceous glands is based primarily on lesion morphology. A confirmatory biopsy is not usually necessary, but can be performed in order to exclude alternative diagnoses. Ectopic sebaceous glands are asymptomatic and do not have any adverse associated sequelae. Therefore, reassurance of the benign nature of the condition is a reasonable alternative to management. If the patient is concerned about the cosmetic features of ectopic sebaceous glands, ablation using electrodesiccation or laser may provide a potential therapeutic alternative.
Mr. Beutler is with the University of Nevada School of Medicine in Reno, NV.
Dr. Cohen, is with the department of dermatology at the University of California San Diego in San Diego, CA.
Disclosure: The authors report no relevant financial relationships.
References
1. Zouboulis CC, Baron JM, Bohm M, et al. Frontiers in sebaceous gland biology and pathology. Exp Dermatol. 2008;17(6):542-551.
2. Scully C. Common complaints. In: Oral and Maxillofacial Medicine: The Basis of Diagnosis and Treatment. 3rd ed. Edinburgh, Scotland: Churchill Livingstone; 2013:170.
3. Halperin V, Kolas S, Jefferis KR, Huddleston SO, Robinson HB. The occurrence of Fordyce spots, benign migratory glossitis, median rhomboid glossitis, and fissured tongue in 2,478 dental patients. Oral Surg Oral Med Oral Pathol. 1953;6(9):1072-1077.
4. Olivier JH. Fordyce granules on the prolabial and oral mucous membranes of a selected population. SADJ. 2006;61(2):72-74.
5. Ackerman AB, Penneys NS. Montgomery’s tubercles. Sebaceous glands. Obstet Gynecol. 1971;38(6):924-927.
6. Batistatou A, Panelos J, Zioga A, Charalabopoulos KA. Ectopic modified sebaceous glands in human penis. Int J Surg Pathol. 2006;14(4):355-356.
7. Bertoni G, Sassatelli R, Nigrisoli E, Conigliaro R, Bedogni G. Ectopic sebaceous glands in the esophagus: report of three new cases and review of the literature. Am J Gastroenterol. 1994;89(10):1884-1887.
8. Wolff M, Rosai J, Wright DH. Sebaceous glands within the thymus: report of three cases. Hum Pathol. 1984;15(4):341-343.
9. Guiducci AA, Hyman AB. Ectopic sebaceous glands. A review of the literature regarding their occurrence, histology and embryonic relationships. Dermatologica. 1962;125:44-63.
10. Trodahl JN, Albjerg LE, Gorlin RJ. Ectopic sebaceous glands of the tongue. Arch Dermatol.1967;95(4):387-389.
11. Kazakov DV, Hejda V, Kacerovska D, Michal M. Hyperplasia of ectopic sebaceous glands in the uterine cervix: case report. Int J Gynecol Pathol. 2010;29(6):605-608.
12. Chern PL, Arpey CJ. Fordyce spots of the lip responding to electrodesiccation and curettage. Dermatol Surg. 2008;34(7):960-962.
13. Ocampo-Candiani J, Villarreal-Rodriguez A, Quiñones-Fernandez AG, Herz-Ruelas ME, Ruiz-Esparza J. Treatment of Fordyce spots with CO2 laser. Dermatol Surg. 2003;29(8):869-871.
14. Baeder FM, Pelino JE, de Almeida ER, Duarte DA, Santos MT. High-power diode laser use on Fordyce granule excision: a case report. J Cosmet Dermatol. 2010;9(4):321-324.
