Oral cavity & oropharynx

Developmental anomalies

Fordyce granules

Editorial Board Member: Kelly Magliocca, D.D.S., M.P.H.
Editor-in-Chief: Debra L. Zynger, M.D.
Molly Housley Smith, D.M.D.

Last author update: 31 August 2020
Last staff update: 22 August 2022

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PubMed Search: Fordyce granules oral

Molly Housley Smith, D.M.D.
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Cite this page: Smith MH. Fordyce granules. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/oralcavityfordyce.html. Accessed February 8th, 2023.
Definition / general
  • Ectopic sebaceous glands within oral cavity or on vermillion border of lips
Essential features
  • Fordyce granules
  • Fordyce spots
ICD coding
  • ICD-10: Q38.6 - other congenital malformations of the mouth
  • Buccal mucosa (often bilateral), upper lip vermilion border, mandibular retromolar pad and tonsillar areas
  • Similar anomalies affect the areolae, glans penis and labia minora
  • Congenital
  • Considered benign sebaceous hamartomas
Clinical features
  • Yellow-white, asymptomatic, floral appearing 1 - 3 mm papules that remain constant throughout life
  • May be hyperplastic and nodular
  • Diagnosed clinically
  • Rarely may require biopsy for identification when hyperplastic or nodular
  • No treatment necessary unless for cosmetic reasons
Clinical images

Contributed by Molly Housley Smith, D.M.D.

Yellow, floral papules

1 - 3 mm yellow-white papules

Image hosted on other servers:

Yellow-white papules

Microscopic (histologic) description
  • Similar to normal sebaceous glands of skin but lack hair follicles and almost always lack ductal communication with surface
  • Parakeratotic stratified squamous epithelium overlies the sebaceous lobules
Microscopic (histologic) images

Contributed by Molly Housley Smith, D.M.D.

Oral mucosa containing sebaceous lobules

Sebaceous lobules adjacent to mucous glands

Sebaceous lobules

Positive stains
  • Although associated with Lynch and Muir-Torre syndromes, which demonstrate defects in DNA mismatch repair (MMR) proteins leading to microsatellite instability, preservation of MMR proteins is noted upon immunostaining of Fordyce granules (Appl Immunohistochem Mol Morphol 2017;25:209)
Sample pathology report
  • Left buccal mucosa, incision:
    • Fordyce granules (see comment)
    • Comment: Microscopic examination reveals parakeratotic stratified squamous epithelium overlying mesenchymal tissue. Within the mesenchymal stroma are numerous sebaceous gland lobules. Hair follicles are not appreciated.
Differential diagnosis
  • Clinically diagnostic and doesn't have a differential diagnosis; often are not even biopsied but found only incidentally on pathology
  • Usually noted on routine examination
Additional references
Board review style question #1

Which of the following is true about this oral mucosal entity?

  1. Immunohistochemistry is necessary to define this process
  2. It is found in higher frequency in those who have Lynch and Muir-Torre syndromes
  3. Neoplastic transformation occurs in the majority of cases
  4. This entity is most frequently found on the tongue
Board review style answer #1
B. It is found in higher frequency in those who have Lynch and Muir-Torre syndromes

Comment here

Reference: Fordyce granules
Board review style question #2
A 43 year old female patient presents to the clinic for a routine head and neck cancer screening. Upon examination, numerous yellow-white papules (approximately 1 - 3 mm in diameter) are present along the upper lip vermillion border and on the right and left buccal mucosa. The patient states that the spots are asymptomatic and thinks that they have always been there. Which is the most likely diagnosis?

  1. Actinic cheilitis
  2. Fordyce granules
  3. Morsicatio buccarum
  4. Salivary gland hyperplasia
Board review style answer #2
B. Fordyce granules

Comment here

Reference: Fordyce granules
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