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Sebaceous Hyperplasia

Author: Dr Amy Prideaux 

Chief Editor: Dr Daniel Keith

Introduction

Sebaceous hyperplasia is a very common and benign skin finding which is often mistaken for a BCC particularly when it is a single lesion. They are soft, often yellowish in colour and can be single or multiple. The yellowish appearance is very helpful when differentiating from a BCC. They typically occur on the face and are more common in elderly and middle aged people. Below are multiple macroscopic and dermoscopic pictures of sebaceous hyperplasia.

Macroscopic Appearance

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Three areas of sebaceous hyperplasia seen on the face indicated by the yellow arrows.

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A single sebaceous hyperplasia (purple arrow). As you can see the area is similar in colour to the surrounding skin but with a subtle yellow tinge.

Further examples of the macroscopic appearance of sebaceous hyperplasia, each indicated by the purple arrows:

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Dermoscopic Appearance

Dermoscopically, findings may include:

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  • White/yellow globules

  • Coronal vessels

  • Arborizing telangiectasias

  • Bonbon toffee sign

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White/yellow globules and coronal vessels can be visualised here.

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Coronal vessels are groups of bending vessels which do not cross the centre of the lesion.

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More difficult to see here, but you can make out the globules and coronal vessels just about!

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White/yellow gobules with faint coronal vessles

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Coronal vessels can be seen here surrounding the globules.

 

On the lower lesion where the arrow is pointing you can also see the bonbon toffee sign (central darkened umbilication surrounded by white/yellow globules)

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Arborizing (branching) telangiectasias may also be seen in sebaceous hyperplasia and are shown here by the arrow.

Below is another example of a sebaceous hyperplasia, but was initially thought to be either a sebaceous adenoma, a sebaceoma (both benign sebaceous tumours), or the rare malignancy sebaceous carcinoma (SC). It was excised to exclude SC and histology confirmed a large area of sebaceous hyperplasia.

 

In dermoscopic analysis of sebaceous carcinomas, a polymorphic vessel pattern (multiple vessel types present without any predominant type) is more common than a monomorphic vessel pattern (coronal or arborizing vessels as seen above). Sebaceous carcinomas may also appear white/pink in colour as well as being yellowish.

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Dermoscopic appearance

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Macroscopic appearance

Multiple sebaceous tumours?

 

Multiple sebaceous tumours – both benign and malignant but not including sebaceous hyperplasia (which is normal), are associated with a genetic condition Muir-Torre Syndrome. M-T syndrome is a variant of Lynch syndrome (HNPCC). So in a younger patient or in the context of multiple tumours we might have to refer to genetics. Patients with M-T syndrome are also at risk of other types of internal (usually bowel) and skin cancer, including MM and SCC, but it is the sebaceous tumours that being rare are the identifier.

References:

Sebaceous hyperplasia. (2019, June 3). dermoscopedia. Retrieved 11:21, March 7, 2023 from https://dermoscopedia.org/w/index.php?title=Sebaceous_hyperplasia&oldid=16375.Cheng CY, Su HJ, Kuo TT. Dermoscopic features and differential diagnosis of sebaceous carcinoma. J Dermatol. 2020 Jul;47(7):755-762. doi: 10.1111/1346-8138.15384. Epub 2020 May 16. PMID: 32415798.

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