Leprosy-associated eccrine syringofibroadenoma of Mascaro H. L. Tey, W. S. Chong and S. N. Wong National Skin Center, Singapore Summary Eccrine syringofibroadenoma of Mascaro is a rare benign tumour. There are five subtypes, one of which is known to occur in reaction to inflammatory and neoplastic dermatoses. We describe a patient with previous lepromatous leprosy presenting with multiple flesh-coloured verrucous plaques over the right foot. Histology was consistent with eccrine syringofibroadenoma. To our knowledge, this is the first reported case of multiple eccrine syringofibroadenomata occurring in association with leprosy. The tumours in this case are most likely reactive in nature, subsequent to multiple traumatic events with tissue remodelling in an insensate foot affected by leprosy. It is less probable that the tumours are a result of scarring from recurrent infections. We also raise the possibility of a neuroeccrine interaction, with sympathetic neuropathy in leprosy as a contributing factor in the pathogenesis. Eccrine syringofibroadenoma of Mascaro (ESFA) is a rare tumour consisting of proliferating ductal structures resembling the acral portion of the sweat gland. It was first described by Mascaro in 1963, and usually occurs in the seventh and eighth decades of life. 1 The clinical presentation is variable and nonspecific, ranging from solitary lesions to multiple papules and nodules. 1,2 The site of occurrence varies widely, including the face, trunk and extremities. We present a case of multiple ESFA occurring in the foot of a patient who had leprosy. Report A 78-year-old Chinese woman presented to our centre with growths on her right foot of about 5 years’ duration. She had been treated for lepromatous leprosy 15 years previously, and about 5 years later, she had developed an infection on the left leg, which had occurred after an injury to the insensate leg. The infection had resulted in an eventual below-knee amputation, and since then, she had been a wheelchair user. Over the past few years, she had also had recurrent cellulitis of the right lower limb and episodes of neuropathic ulcers. Other comorbidities were chronic schizophrenia, epilepsy and hypertension, for which she was being treated with haloperidol, phenytoin and amlodipine. On clinical examination, there were multiple flesh- coloured, verrucous plaques on the distal side of the right foot, over the plantar side of the toes, the lateral border of the foot, and the sole (Fig. 1). There was resorption of the toes. There was extensive scarring, with areas of postinflammatory hyperpigmentation and hypopigmentation seen over the dorsum of the foot extending up to the knee. The skin over the lower limb was also dry and eczematous. Neurological examination revealed loss of pain and temperature sensation over the right foot up to the knee. The clinical differential diagnoses of viral warts, squamous cell carcinoma, tuberculosis verrucosa cutis, and chromoblastomycosis were considered. Two skin biopsies performed on two anatomically separated verrucous plaques revealed similar histological features. There were thin, anastomosing epithelial cords and strands of clear cells connected to the undersurface of the epidermis (Fig. 2). There was a fibrovascular stroma, and ductal structures were seen within the Correspondence: Dr Hong Liang Tey, MBBS, MRCP, Grad Dip Geri Medical, Registrar, National Skin Center, Singapore, 1, Mandalay Road, Singapore 308205. E-mail: hltey@nsc.gov.sg Conflict of interest: none declared. Accepted for publication 10 February 2007 Clinical dermatology • Concise report doi: 10.1111/j.1365-2230.2007.02434.x Ó 2007 The Author(s) Journal compilation Ó 2007 Blackwell Publishing Ltd • Clinical and Experimental Dermatology, 32, 533–535 533