Spiradenoma - Causes, Types, and Treatment

Introduction

Spiradenomas are dermal neoplasms that are often benign. These are well-differentiated tumors developing from sweat glands. They develop into nodular-like growth that is solitary. Spiradenoma occurs between the age of 15 to 35 years, with few occurrences among infants. There are cases reported in individuals above the age of 50. However, there is no gender and race discrimination. They are usually very painful. Spiradenomas are rare disorders with the rarest frequency of malignant transformation.

What Is the Cause for Spiradenoma?

A benign tumor is an abnormal growth of cells that is not cancer. It does not invade or spread to adjacent tissues or distant parts of the body. Benign tumors are very common and can occur in any part of the body. They are slow-growing, and microscopically they appear to have smooth and distinctive borders. The cells are well-differentiated.

The exact cause of spiradenoma is unknown. Few studies suggest spiradenoma is caused due to a defect in the tumor suppressor gene. Mutation in CYLD (CYLD Lysine 63 Deubiquitinase) gene is responsible for spiradenoma. Spiradenoma can be solitary or multiple. Multiple spiradenomas are found to be associated with Brooke-Spiegler syndrome. The cause of solitary spiradenoma remains to be unknown.

What Are the Types of Spiradenoma?

Spiradenoma is a benign tumor of the epidermis developing from sweat glands. Sweat glands are of two types:

1. Eccrine Glands - Sweat glands are present all over the body. Eccrine glands are mostly located on palms and soles. These glands play an important role in maintaining body temperature. Eccrine glands secrete a solution that contains sodium chloride, potassium with many other elements along with antimicrobial peptides.

2. Apocrine Glands - These sweat glands are known to secrete oily fluid that is rich in fatty acids and triglycerides. This secretion is responsible for body odor. Spiradenoma is believed to be of eccrine, but recent studies have proved that it may be developed from apocrine glands too. They can also be found along with cylindroma, trichoepithelioma, and trichoblastoma.

How Does Spiradenoma Look Like?

Spiradenoma most frequently appears in the solitary form. They are skin-colored, blurred, or pink nodules ranging from one centimeter to many centimeters. They are mostly found on the neck and scalp and are mostly restricted to the upper body. Spiradenoma is also found to develop in ears and eyelids. They are soft and spongy with well-demarcated borders. They are mostly found in the singular form. When spiradenomas are multiple, they are associated with cylindromas and trichoblastoma. They are often asymptomatic but can be painful sometimes. A solitary spiradenoma that is long-standing may transform into malignant spiradenoma if left untreated. A change in color of the lesion is an indication of transformation into malignant spiradenoma.

How Is Spiradenoma Diagnosed?

Spiradenoma is impossible to diagnose without a biopsy. The signs and symptoms are much similar to other disorders like:

• Angiolipoma.

• Dermatofibroma.

• Epidermal inclusion cyst.

• Leiomyoma.

• Poroma.

• Schwannoma.

Tests that help in diagnosing spiradenoma are:

• Magnetic resonance imaging (MRI).

• Computed tomography (CT).

• X-ray.

• Histopathological studies.

• Immunohistochemistry.

• Electron microscopy.

• Imaging Studies - These studies cannot alone diagnose spiradenoma; rather, imaging studies help to locate the multiple foci and determine the size of the benign lesion. Microscopic imaging is best when it comes to the diagnosis of spiradenoma. A biopsy is performed to obtain tissue specimens from benign lesions. This procedure is done under local anesthesia to avoid discomfort to the patient. The samples are then sent to the laboratory, where these samples are studied under the microscope.

• Histopathological Findings - These findings during microscopic examination determine the presence of spiradenoma. The cellular abnormalities, along with other findings, will be recorded and sent to the doctor, who then concludes spiradenoma.

• Electron Microscopy - This microscopic examination uses electrons that act as a source of illumination radiation-producing high-resolution images of the tissue samples. An electron microscope provides key information regarding cellular structure, function, and disease.

Does Spiradenoma Spread?

Tumors arising from sweat glands are unusual. Spiradenomas mostly develop in solitary forms. They rarely undergo malignant transformation. Benign lesions have slow growth, and they don't spread to surrounding tissues or organs of the body. The clinical course of spiradenoma is supposed to be good. Spiradenomas on long-standing may undergo malignant transformation with multiple spiradenomas.

What Are the Complications of the Spiradenoma?

Spiradenoma does not cause any local or systemic complications unless the malignant spiradenoma. It can be esthetically disturbing to patients, especially when spiradenomas are multiple.

What Is the Treatment for Spiradenoma?

Generally, when there is a benign lesion, treatment options widely fall under two options:

• Systemic Treatment.

• Local Treatment.

Benign spiradenoma does not need any systemic therapy. For solitary lesions, doctors do not prescribe any medications. Local therapy includes:

1. Local Excision - This involves the excision of the entire lesion under anesthesia. Researchers advised removing an extra 1 cm around and under the lesion to avoid any chance of recurrence. It has chances of secondary infection and scarring. Local excision can be performed for both benign and malignant lesions.

2. Excisional Biopsy - Excision of the tumor lesion during the biopsy is called an excisional biopsy. This is avoided as it carries the risk of leaving cancer cell remnants at the site.

3. Mohs Micrographic Surgery - Mohs micrographic surgery uses a smaller incision to remove the tumor instead of the incision used in local excision. Since spiradenomas are of esthetic concern, it is best suited when spiradenomas are located on the face and neck. It has minimum scarring and enables the doctor to kill the cancer cells micro graphically, which otherwise is impossible.

4. Carbon Dioxide Laser Therapy - This gives the best cosmetic treatment outcomes. The laser uses waves in continuous mode, 10.0 W. It vaporizes multiple tumors on the face.

Conclusion:

Spiradenomas are generally benign lesions that are stable. Though not serious, spiradenomas cause pain and discomfort. Benign lesions, when left untreated, have the chance to undergo malignant transformation. The whole lesion must be excised during surgery. The patient must be explained the chances of malignant transformation if it is left for a long duration.