a 58-year - old male presented with a lesion on the medial aspect of left lower eyelid near the punctum . he had a small elevated nodular swelling at the margin of the eyelid for the past two decades . there was a gradual increase in the size of the swelling for past 4 years , however , during past 6 months it became more visible associated with discomfort , itching , and a noticeable mass . physical examination revealed a solitary 2 cm  2 cm size brownish firm fleshy growth with hyperkeratotic surface covered with crusts in some areas , involving the skin of the left lower eyelid [ fig . 1 ] . it did not involve the underlying deeper tissues also and there was no regional lymphadenopathy . fleshy growth with hyperkeratotic surface covered with crusts in some areas , involving the skin of the left lower eyelid the mass was excised along with a 3 mm margin of healthy skin , and the resultant skin defect was repaired with a median frontoglabellar pedicle skin flap . the final pathologic diagnosis of excision biopsy specimen confirmed syringocystadenoma papilliferum . on gross examination , skin covered tissue measuring 1.3 cm  1.1 cm  1 cm . this showed a nodular lesion 0.7 cm in its greatest axis 0.3 cm away from the nearest peripheral surgical cut margins . on microscopic examination , section showed a nodular lesion lined by epidermis with varying degree of papillomatosis [ fig . 2 ] . these were lined by two rows of cells . the luminal row consisted of columnar cells with evidence of active  decapitation  secretion and outer row of cells composed of small cuboidal cells . on gross examination , skin covered tissue measuring 1.3 cm  1.1 cm  1 cm . this showed a nodular lesion 0.7 cm in its greatest axis 0.3 cm away from the nearest peripheral surgical cut margins . on microscopic examination , section showed a nodular lesion lined by epidermis with varying degree of papillomatosis [ fig . 2 ] . these were lined by two rows of cells . the luminal row consisted of columnar cells with evidence of active  decapitation  secretion and outer row of cells composed of small cuboidal cells . syringocystadenoma papilliferum is a rare benign tumor that is believed to be derived from the apocrine or the eccrine sweat glands . in a recent report , immunohistochemistry proved the apocrine nature of the benign , noncystic lesion by virtue of its nuclear androgen receptor and cytoplasmic gross - cystic disease fluid protein-15 positivity , along with its smooth muscle actin - positive myoepithelial layer . this is predominantly a childhood tumor ; however presentation at a later stage like our case has been described in literature . in half of those who are affected , it is present at birth , and in a further 1530% , the tumor develops before puberty . the lesion is frequently misdiagnosed as basal cell carcinoma or cyst or squamous cell carcinoma . in a series of 14 patients , this is unlike other benign eyelid lesions , where histopathological diagnosis confirms clinical diagnosis in 95.9% cases . tumor is usually described as a skin colored to pink , hairless , firm plaque of grouped nodules or as a solitary nodule . cauliflower like , verrucous , papillary , hyperkeratotic , or sometimes moist fleshy excrescences have also been described . most of the lesions develop and enlarge slowly , although a few can increase to significantly within a short period . the plaque type that presents a hairless area of the scalp is commonly associated with a sebaceous nevus of jadassohn . in about one - third of the case , appearance of the lesion in the face and neck region is seen in the linear type ; however , a solitary nodular type shows predilection for the trunk . syringocystadenocarcinoma papilliferum is a malignant counterpart of syringocystadenoma papilliferum . the diagnosis is clinically suspected and histologically confirmed . ulceration or a rapid enlargement of an existing tumor is indicative of a malignant transformation . we were suspicious in the index case because of the recent increase of size . in about one - tenth of cases of syringocystadenoma papilliferum squmaous cell carcinoma may also develop , but much less frequently . because of this , surgical excision is the treatment of choice . in our case , excision of the tumor was done followed by repair of skin defect with median frontoglabellar pedicle skin flap .