Fordyce Granules
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Small cauliflower-like white/yellow submucosal nodules.

 

 

 

 

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Introduction

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Sebaceous glands are normal adnexal structures of the dermis but may also be found within the mouth, where they are referred to as Fordyce granules or ectopic sebaceous glands. This variation of normal anatomy is seen in the majority of adults, perhaps as much as 80% of them, but seldom are granules found in large numbers. Examples reported in a cancer screening represent approximately 1% of adults (Table 1).  When seen as a streak of individual glands along the interface between the skin of the lip and the vermilion border, the terms Fox-Fordyce disease and Fordyce's condition have been used. Fordyce first described this condition in 1896.

Fordyce granules appear as rice-like, white or yellow-white, asymptomatic papules of 1-3 mm. in greatest dimension (Figures 1 & 2). There is no surrounding mucosal change and the granules remain constant throughout life. The most common sites of occurrence are the buccal mucosa (often bilateral), the upper lip vermilion, and the mandibular retromolar pad and tonsillar areas, but any oral surface may be involved. Some patients will have hundreds of granules while most have only one or two.

Occasionally, several adjacent glands will coalesce into a larger cauliflower-like cluster similar to sebaceous hyperplasia of the skin. In such an instance, it may be difficult to determine whether or not to diagnose the lesion as sebaceous hyperplasia or sebaceous adenoma. The distinction may be moot because both entities have the same treatment, although the adenoma has a greater growth potential. It should be mentioned that sebaceous carcinoma of the oral cavity has been reported, presumably arising from Fordyce granules or hyperplastic foci of sebaceous glands.

Fordyce granules are usually not biopsied because they are readily diagnosed clinically, but they are often seen as incidental findings of mucosal biopsies of the buccal, labial and retromolar mucosa. The granules are similar to normal sebaceous glands of the skin but lack hair follicles and almost always lack a ductal communication with the surface (Figures 3 & 4). The glands are located just beneath the overlying epithelium and often produce a local elevation of the epithelium. Individual sebaceous cells are large, with central dark nuclei and abundant foamy cytoplasm. The surrounding stroma may contain occasional chronic inflammatory cells because of trauma with adjacent teeth.

Large numbers of lobules coalescing into a definitely elevated mass may be called benign sebaceous hyperplasia, and occasional small keratin-filled pseudocysts may be seen and must be differentiated from epidermoid cyst or dermoid cyst with sebaceous adnexa. The pathologist must be careful to differentiate such lesions from salivary neoplasms with sebaceous cells, such as sebaceous lymphadenoma and sebaceous adenoma, and their malignant counterparts sebaceous lymphadenocarcinoma and sebaceous carcinoma.

No treatment is required for Fordyce granules, except for cosmetic removal of labial lesions. Inflamed glands can be treated topically with clindamycin. When surgically excised, recurrence does not occur. Neoplastic transformation is very rare but has been reported.

Fordyce J. A peculiar affection of the mucous membrane of the lip and oral cavity. J Cutan Genito-Urin Dis 1896; 14:413-419.

Miles AEW. Sebaceous glands in the lip and cheek mucosa of man. Br Dent J 1958; 105:235-239.

Miller AS, McCrea MW. Sebaceous gland adenoma of the buccal mucosa. J Oral Surg 1968; 26:593-595.

Gorsky M, Buchner A, Fundoianu-Dayan D, Cohen C. Fordyce's granules in the oral mucosa of adult Israeli Jews. Community Dent Oral Epidemiol 1986; 14:231-232.

Rhodus NL. An actively secreting Fordyce granule: a case report. Clin Prev Dent 1986; 8:24-26.

Ellis GL, Auclair PL, Gnepp DR. Surgical pathology of the salivary glands. Philadelphia; W.B. Saunders, 1991.

Miller ML, Harford RR, Yeager JK. Fox Fordyce disease treated with topical clindamycin solution. Arch Dermatol 1995; 131:1112-1113.

Abuzeid M, Gangopadhyay K, Rayappa CS, Antonios JI. Intraoral sebaceous carcinoma. J Laryngol Otol 1996; 110:500-502.

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