Trichoepithelioma

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INTRODUCTION Trichoepithelioma is a benign adnexal tumor of hair follicle origin that may occur as a solitary lesion or as an inherited form with multiple lesions, each with a predilection for the face. They can occur at any age, but the mean age is 45 years. Solitary lesions tend to present in older patients. These lesions are nonaggressive and assymptomatic, but may cause significant cosmetic disfigurement. Multiple lesions may occur in an inherited, autosomal dominant pattern called epithelioma adenoids cysticum of Brooke. This syndrome begins in the second decade of life with the appearance of multiple lesions that tend to involve the face, particularly in the region of the nasolabial folds, lips, nose, and eyelids. The scalp, neck, and trunk may also be involved.

CLINICAL PRESENTATION The solitary lesion presents as an asymptomatic, flesh-colored to yellowish, firm dome-shaped papule, 2 to 8 m in diameter. Telangiectatic vessels may be seen. In overall configuration it may mimic the appearance of a basal cell carcinoma. With time, these lesions may increase in size and number. Only rarely will they ulcerate.

Eyelid Cylindroma

(Courtesy of Morris Hartstein, M.D.) (Courtesy of Robert Dryden, M.D. and

(Courtesy of Morris Hartstein, M.D.) (Courtesy of Robert Dryden, M.D. and

HISTOPATHOLOGY Trichoepitheliomas are dermal tumors composed of islands of basaloid cells that may exhibit peripheral palisading. Trichoepitheliomas often have small keratinous cysts lined by stratified squamous epithelium. Epithelial structures resembling hair papillae or abortive hair follicles usually allow the trichoepithelioma to be differentiated from a basal cell carcinoma.

Trichoepithelioma

In some cases, immunostaining with antibodies to bcl-2 may be needed to distinguish a trichoepithelioma from a basal cell carcinoma: bcl-2 is predominantly peripheral in trichoepithelioma, while it is expressed diffusely in basal cell carcinoma.

DIFFERENTIAL DIAGNOSIS Differential diagnosis includes basal cell carcinoma, syringoma, cylindroma, mila, trichilemmoma, and trichofolliculoma.

TREATMENT Treatment includes surgical excision of solitary lesions, and dermabrasion, cryosurgery, or laser ablation for multiple lesions.

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