Cutaneous apocrine-derived eyelid lesions: a series

Eyelid lesions with apocrine differentiation are uncommon. A retrospective review of 1,920 biopsied sweat gland lesions at a tertiary hospital's ocular pathology laboratory from 2006 to 2024 revealed seven unique cutaneous eyelid tumors with sweat gland apocrine differentiation. The distinct clinical presentation and histopathologic features of the selected eyelid tumors are described. The lesions were further differentiated based on immunohistochemical analysis. Seven patients were identified with enlarging unilateral eyelid sweat gland lesions. All lesions underwent excisional biopsy and demonstrated unique histopathologic findings of apocrine lesions. Key hallmark features in all lesions included bi- or multi-layered epithelium, decapitation secretion, and eosinophilic pink cytoplasms. However, each lesion also had its own distinct characteristics (e.g. pseudopapillary projections in cystadenoma) that guided in highlighting its benign or malignant apocrine-differentiation. Immunohistochemical staining was helpful in distinguishing the seven lesions as the following: apocrine cystadenoma, syringocystadenoma papilliferum, three tubular apocrine adenomas, and two apocrine adenocarcinoma of the glands of Moll. Lesions were managed with surgical excision. Eyelid sweat gland lesions with apocrine differentiation are less understood. They are frequently misdiagnosed, ranging from a benign chalazion to malignant basal cell carcinoma. If a biopsy reveals malignancy in an apocrine sweat gland lesion, it can be challenging to manage with surgical excision and adequate margins in the eyelid given the limited skin area. Early biopsy and detection of distinguishing histopathologic features can help reduce the growth of the lesion and prevent delayed diagnosis and treatment.