A Case of Recurrent Eyelid Cutaneous Myxoma With Basaloid Proliferation in a Child

Cutaneous myxomas are extremely rare in the pediatric population. We describe a case of an eyelid cutaneous myxoma with multiple recurrences in an 8-year-old child. The lesion once previously diagnosed as eccrine hidrocystoma had been excised three times with subsequent recurrence. Frozen section diagnosis performed during the fourth excision showed striking basaloid features, prompting deferral of definitive diagnosis to permanent sections. Following routine processing, basaloid proliferations were again seen without significant atypia or mitotic activity in addition to background features of myxoma. CD10 immunostain highlighted both basaloid nests and surrounding stroma. Cutaneous myxoma was diagnosed. The diagnosis was corroborated by an external consultation. The patient underwent genetic testing for the Carney complex with negative results. This case report raises some practical points. First, due to their rarity in the pediatric population and potential to mimic other entities, cutaneous myxomas can be misdiagnosed as other benign neoplasms. Second, although induction of basaloid proliferation has been well-documented in myxoma, it can be easily misinterpreted as a malignant process, particularly in the setting of a frozen section diagnosis and lack of available clinical information. Third, even though solitary cutaneous myxomas are less likely to be associated with the Carney complex, a possibility of such an association should always be born in mind, as consequences of missing syndromic neoplasms, such as cardiac myxoma, can be lethal.