Treating Clear Cell Hidradenoma Of The Dorsal Medial Forefoot

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Author(s): 
Jane Pontious, DPM, and Kerianne Spiess, BA, BS

   The surgeon then flushed the area with normal sterile saline and closed the wound sequentially with 2-0 Vicryl. The surgeon subsequently closed the skin with 4-0 nylon in a vertical mattress and simple suturing pattern, and applied a bandage. The patient left the hospital in stable condition and had no complications.

   Pathologists examined two specimens: a 2.2 x 2 x 1.5 cm rubbery tan soft tissue nodule and a 2 x 1 cm, partially bisected brown skin surface. Microscopic examination revealed the mass was a clear cell hidradenoma that was incompletely excised.
The patient followed up in the office weekly. At the first postoperative visit, the incision site was intact with no evidence of dehiscence, infection or recurrence. She reported a decrease in pain to the area. During the second postoperative visit, suture removal occurred without incident. At the six-month follow-up, there was no recurrence of the mass and the patient had returned to wearing normal shoe gear without any difficulties.

Final Words

Clear cell hidradenomas are generally asymptomatic, benign, slow-growing adnexal tumors. These neoplasms have both mixed solid and cystic components with the clear cells resulting from increased glycogen within the cytoplasm.1 Often, they are encapsulated and researchers have reported that they can be highly vascularized with vessels that may extend through the lobules of the neoplasm.1

   There are many synonyms for clear cell hidradenomas. These synonyms include benign nodular hidradenoma, clear cell myoepithelioma, eccrine acrospiroma and eccrine sweat gland adenoma.1,5 These lesions are generally solid and cystic with a predilection toward the trunk, face and upper extremities. There is an approximately 3 percent incidence on the foot.1,2,6 Skin changes can occur. These changes may include thickening, ulceration, discharge, discoloration and tenderness. This tumor can occur at any age but it is most common in the fourth decade.1,2 However, there have been cases in patients as young as 3.5 years old.7

   The treatment of choice is surgical excision as the rate of local recurrence is low.1-3,6,8 The potential for malignant change is low but studies have reported a malignancy rate of up to 6.7 percent.2,3,9

   Due to the patient’s age and the fact that she had remained asymptomatic postoperatively, the surgeon decided not to perform a second surgical procedure to completely excise the remaining aspects of the mass. The patient continues regular follow-up and monitoring for recurrence of the mass.

   Dr. Pontious is the Acting Chair of the Department of Podiatric Surgery and Assistant Dean of Clinical Education at Temple University School of Podiatric Medicine in Philadelphia.

   Ms. Spiess is a fourth-year student at the Temple University School of Podiatric Medicine.

   The authors thank Patrick Odgen, DO, a pathologist at Aria Hospital in Philadelphia.

References
1. Winkelmann RK, Wolff K. Solid-cystic hidradenoma of the skin. Arch Derm. 1968; 97(6):651-657.

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