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Dr. Andrew Rynne

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What are the signs and symptoms of Lynch syndrome?

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Dr. Diptanshu Das

Pediatrician

Practicing since :2005

Answered : 3740 Questions

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Posted on Tue, 28 Mar 2017 in Genetics
Question: Hello....my question pertains to Lynch Syndrome. I've been diagnosed with numerous fordyce spots on my lips and inside my cheeks, and I also have sebaceous hyperplasia.

I've been suffering from health anxiety, and unfortunately, I made the mistake of consulting "Dr. Google" and ran across some information implying that fordyce spots can be related to Lynch Syndrome (and sebaceous hyperplasia to Muir Torre). I understand that fordyce spots and hyperplasia is benign and relatively common, and the familial cancer syndromes are rare. Is there any connection between them, and can fordyce spots be a marker for Lynch syndrome?

I just had my first screening colonoscopy, which came back clean, and there is no history of cancer in my family. I've also had routine blood work done, all normal, as were my yearly mammograms and Pap smears, as well as a pelvic ultrasound.

Thank you for any insight you can provide!!
doctor
Answered by Dr. Diptanshu Das 56 minutes later
Brief Answer:
Criteria mentioned

Detailed Answer:
Thanks for asking on HealthcareMagic.

I would not get apprehensive enough to connect Fordyce spots or sebaceous cysts to Lynch syndrome. Unless you have a history of colorectal carcinoma you need not bother to think about these. It is only if you are genetically at a higher risk that you should be concerned about. I would not consider Fordyce spots to be a marker of Lynch syndrome.

The following are the Amsterdam criteria in identifying high-risk candidates for molecular genetic testing for Lynch syndrome:

Amsterdam Criteria (all bullet points must be fulfilled):
* Three or more family members with a confirmed diagnosis of colorectal cancer, one of whom is a first degree (parent, child, sibling) relative of the other two
* Two successive affected generations
* One or more colon cancers diagnosed under age 50 years
* Familial adenomatous polyposis (FAP) has been excluded

Amsterdam Criteria II (all bullet points must be fulfilled):
* Three or more family members with HNPCC-related cancers, one of whom is a first-degree relative of the other two
* Two successive affected generations
* One or more of the HNPCC-related cancers diagnosed under age 50 years
* Familial adenomatous polyposis (FAP) has been excluded

Unless you fulfill all these criteria, get that off your mind.

Feel free to write back.

Regards
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Diptanshu Das 46 minutes later
Dr. XXXXXXX thank you so very much for your informative and reassuring answer to my (neurotic) question! The criteria is very interesting, and I see how very specific it is -- I certainly do not meet ANY of the points for either of the criteria, thankfully!

I've told myself time and again not to google health conditions, as I always look too deep into them and run into the obscure and rare conditions. I think I had stumbled upon two research studies done that showed most of the relatives affected with Lynch syndrome also had fordyce spots, but that research also showed that 50 percent of the unaffected family members had the fordyce spots as well. Googling is definitely not the solution for someone who suffers from health anxiety!

I realistically knew that there fordyce probably was not a marker, as I understand around 80 percent of the population has fordyce spots and Lynch syndrome only affects something like .2 percent of the population, but hearing your reassurances as a physician has made all the difference!

This may or may not be your area of expertise, but do you know whether it is possible for fordyce spots to appear (or become more prominent) relatively quickly? I knew that I always had a lot of them inside my cheeks, but I've just noticed them throughout my lips. I think my hormones are in turmoil due to peri menopause in full swing, and I've been suffering from anxiety and stress lately (despite being on Cymbalta). Thank you again!!
doctor
Answered by Dr. Diptanshu Das 42 minutes later
Brief Answer:
Hormonal imbalance is the cause.

Detailed Answer:
Thanks for writing back. Hormonal instabilities are a primary cause of rapid increase in the Fordyce spots or sebaceous collections under the skin. This has two components, the increased secretion of sebum and the inability of sebum to escape due to blockage of the openings. If both of these are present, their number can rapidly go up. I would insist you to wash your face (and other areas) frequently with plain water to avoid dust and other particulate matter blocking the openings of the sebaceous glands, and also to wash off the excess sebum.

Forget about Lynch syndrome.

The problem with the internet as a source of information is that you do not get the 'whole' information anywhere and therefore do not know what is relevant for you. Rare things occur rarely but you would find it hard to filter the data. That is exactly the problem with Dr. Google.

Let me know if I could help further.

Regards
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Diptanshu Das 22 minutes later
Many thanks to you once again for your expert answers and reassurances Dr. Das! I can tell that you are an incredibly kind and compassionate physician, and please know that you have put my mind completely at ease.... You truly make a difference in people's lives most certainly in your medical practice, but also in this particular forum.

Thank you again and God bless...
doctor
Answered by Dr. Diptanshu Das 3 minutes later
Brief Answer:
Glad to be of service

Detailed Answer:
I am glad that you felt assured. Feel free to contact me back if you ever have a health related query in the future. I possibly have an extensive understanding of many things which should be sufficient to help you out.

Wish you health.

Regards
Above answer was peer-reviewed by : Dr. Yogesh D
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