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A 65-year-old man noted a new growth on his face for 1 year (Figure 159-1). On close examination, the growth was pearly with a few telangiectasias. The doughnut shape and presence of sebaceous hyperplasia scattered on other areas of the face were reassuring that this may be nothing but benign sebaceous hyperplasia. To reassure the patient and to remove the lesion a shave biopsy was performed to rule out basal cell carcinoma (BCC). The patient was relieved when the pathology result was in fact sebaceous hyperplasia. Additionally, he was pleased with the cosmetic result.

Figure 159-1

Large single lesion of sebaceous hyperplasia that was removed by shave biopsy to confirm that it was not a basal cell carcinoma. Doughnut shape visible. (Courtesy of Richard P. Usatine, MD.)

Sebaceous hyperplasia (SH) is a common, benign condition of sebaceous glands consisting of multiple asymptomatic small yellow papules with a central depression. The sebaceous lobules of SH are greater in number and higher in the dermis than normal sebaceous glands and only 1 gland appears enlarged.1 Consequently, the term hyperplasia appears to be a misnomer, and SH is more accurately classified as a hamartoma (disorganized overgrowth of tissue normally found at that site).1

  • SH occurs in approximately 1% to 26% of the adult population; the latter number is from a population study of hospitalized patients with a mean age of 82 years.1
  • The prevalence of SH is increased in those with immunosuppression by 10-fold to 30-fold1; for example, 10% to 16% of patients receiving long-term immunosuppression with cyclosporine in one study had SH.2
  • SH has also been reported in infants where they are considered physiologic,3 and in young adults who may have a family history of SH.1
  • SH has been reported overlying other skin lesions including neurofibromas, melanocytic nevi, verruca vulgaris, and skin tags.1
  • Rare forms of SH include giant linear (up to 5 cm in diameter) and functional familial (also called premature or diffuse SH); the latter occurring typically around puberty as thick plaque-like lesions with pores resembling an orange peel.1

  • Sebaceous glands, a component of the pilosebaceous unit, are found throughout the skin, everywhere that hair is found. The greatest number is found on the face, chest, back, and the upper outer arms.
  • The glands are composed of acini attached to a common excretory duct. In some areas, these ducts open directly to the epithelial surface, including the lips and buccal mucosa (i.e., Fordyce spots), glans penis or clitoris (i.e., Tyson glands), female areolae (i.e., Montgomery glands), and eyelids (i.e., meibomian glands).1
  • Sebaceous glands are highly androgen sensitive and become increasingly active at puberty and reach their maximum by the third decade of life.
  • The cells that form the sebaceous gland, sebocytes, accumulate lipid material as they migrate from the basal layer ...

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