Multiple Eyelid Cysts With Palmoplantar Hyperkeratosis

A 62-year-old white man presented with multiple asymptomatic eyelid cysts that had gradually increased in number over the past 20 years. He also had palmoplantar hyperkeratosis, which had increased in severity after he underwent a cadaveric renal transplantation for end-stage renal disease due to focal glomerulosclerosis 3 years earlier. He was on a regimen of immunosuppressive agents (mycophenolate, prednisone, and cyclosporine) and had a history of multiple skin cancers, including both squamous and basal cell carcinoma. He also had a melanoma more than 40 years ago. He also reported that he had never developed permanent teeth. His family included 1 son, 1 daughter, 5 sisters, and 4 brothers, all of whom had no notable skin abnormalities. Physical examination revealed multiple yellowwhite papules on the patient’s eyelids (Figure 1). His palms and soles were erythematous, with diffuse hyperkeratosis, resulting in fissuring, especially on the soles (Figure 2). He also had dystrophic nails and mild hypotrichosis of the scalp and eyebrows. Multiple potassium hydroxide preparations and fungal cultures from the palms and soles were negative for organisms. A skin biopsy specimen was obtained from an eyelid cyst. (Figure 3). What is your diagnosis?