“Save my tears”: Rare presentation of Hidradenoma papilliferum

Hidradenoma papilliferum (HP) is a rare benign adnexal tumor, most commonly arising in the anogenital region of middle-aged women. Ectopic hidradenoma papilliferum (EHP) is an uncommon variant that occurs in apocrine-rich or modified apocrine gland-bearing sites, such as the eyelid, external auditory canal, and scalp. Due to its atypical presentation and non-specific clinical appearance, EHP can mimic a wide range of benign and malignant lesions, often leading to misdiagnosis. We present the case of a 57-year-old male with an unusual nodulocystic lesion on the right lower eyelid margin, which was histopathologically confirmed as HP. The clinical, dermoscopic, and histopathological features are discussed with emphasis on the diagnostic challenges and differential diagnoses. Complete surgical excision remains the treatment of choice, with excellent prognosis and minimal risk of recurrence. Awareness of this rare entity is crucial for dermatologists and pathologists to ensure accurate diagnosis and prevent unnecessary aggressive interventions.