Question:

A 50-year old gentleman came to see you for a number of lumps on his face which have been noticed for almost a year. He was worrying about skin malignancies. On physical examination you found four dome-shaped papules on his forehead, diameters ranged from 2-3mm, all yellowish, and one lesion had an umbilicated centre. Features of solar damages were minimal and there were no cervical lymph nodes.

Answer: B. Sebaceous hyperplasia

The gentleman has multiple papules of sebaceous hyperplasia. Sebaceous hyperplasia is a benign condition which most often appears on the face and forehead of adults. Lesions are yellowish dome-shaped papules, some with central umbilication, with size ranges from 2-4mm in diameter. Careful examination with a hand lens may find lobules growing out from the centre. Lesion may be single or multiple. Patients receiving haemodialysis or immunosuppression therapy have more chance of developing sebaceous hyperplasia.

Many modalities of treatments are available for sebaceous hyperplasia: shave excision, curettage with electrodesiccation, trichloroacetic acid destruction, isotretinoin, cryosurgery, carbon dioxide ablation and pulsed dye laser photothermolysis. Patient receiving any of these treatments must be warned of the possibilities of depressed scar, dyspigmentation and recurrence.

Not uncommonly, especially for larger and solitary lesions, sebaceous hyperplasia may be mistaken as basal cell carcinoma. When in doubt, a biopsy should be taken. Xanthelasmas present as flat yellowish plaques usually on the palpebral area. Plane warts are flat-topped papules with a slightly scaly surface and are rarely confused with sebaceous hyperplasia if they are examined carefully.