Giant and atypical eccrine tumors of the eyelid: A clinicopathologic analysis

To analyse the clinicopathological features, diagnostic pitfalls, and unusual presentations of eyelid eccrine tumors. Methods: Retrospective case series of 25 histopathologically confirmed eyelid eccrine tumors surgically excised between 2016 and 2023. Clinical records, histopathology (H&E with selective PAS staining), and follow-up data were reviewed. Results: Eccrine hidrocystoma was the most common subtype (80%, n=20), followed by eccrine hidradenoma (16%, n=4) and eccrine spiradenoma (4%, n=1). Mean patient age was 43.8 years, with a 4:1 male predominance. Clinical misdiagnosis occurred in 84% of lesions, most commonly as sebaceous cysts (64%). cases demonstrated unusual features, including three giant hidrocystomas (>2 cm), one giant hidradenoma (3.0 cm) with ulceration and mechanical ptosis clinically suspicious for squamous cell carcinoma, and one spiradenoma with maggot infestation mimicking malignancy. All giant tumors required excision with reconstruction (e.g., staged Cutler-Beard procedure). No recurrences were observed during follow-up (mean 14 months; range 6-24 months). Conclusion: Eyelid eccrine tumors present a broad clinical spectrum, from small cysts to large masses mimicking malignancy. Giant lesions, though rare, cause diagnostic confusion and functional impairment. Histopathological examination remains the gold standard for definitive diagnosis, and heightened clinical awareness is essential to avoid misdiagnosis.