Solitary Violaceous Nodule on the Face

A 77-year-old man had an asymptomatic preauricular papule for several years. He had no prior skin cancers. The lesion was a solitary, smooth, well-circumscribed, plum-colored dermal nodule, 1.5 cm in diameter (Fig 1). He also had prominent midfacial sebaceous hyperplasia. No lymphadenopathy was noted, and the examination of his ears, nose, and throat was unremarkable. A shave biopsy was performed and the specimen submitted for routine (Figs 2 and 3) and special stains. What is your diagnosis?

Dermal cylindroma (also known as cylindroma, dermal eccrine cylindroma, Spiegler's tumor, turban tumor, and tomato tumor).

This distinctive but uncommon skin tumor was first described by Ancell in 18421 and given the name cylindrom ("cylindroma") by Billroth in 1859.2 The qualifier dermal cylindroma distinguishes this tumor from adenoid cystic carcinoma of the salivary glands, also called cylindroma. Cylindromas are usually firm, smooth, pink-to-red dermal.