Multiple Periocular Eccrine Hidrocystomas Mimicking Malignancy: A Clinicopathologic Diagnostic Challenge

Hidrocystomas are benign cystic tumors of sweat gland origin that may arise from eccrine or apocrine structures and frequently involve the periocular region. Their clinical resemblance to both benign and malignant adnexal lesions represents a diagnostic challenge. We report a case of multiple periocular eccrine hidrocystomas in a man in his 50s presenting with bilateral translucent cystic papules along the eyelid margins. Histopathologic evaluation revealed a well-circumscribed dermal cyst lined by a double layer of cuboidal epithelial cells without decapitation secretion, confirming eccrine differentiation. Given the potential for misdiagnosis as basal cell carcinoma or other adnexal neoplasms, accurate clinicopathologic correlation is essential to prevent unnecessary aggressive interventions. This case highlights distinguishing features, expands the differential diagnosis, and underscores the importance of histopathology in periocular cystic lesions.